“Myers and Stauffer’s staff are highly qualified individuals, knowledgeable in the areas of rate reimbursement, and dedicated to meeting the goals and objectives of the state.”
— [State] Administrator Department of Human Services

Hospital Reimbursement

ARE YOUR HOSPITAL REIMBURSEMENT PROGRAMS UP TO DATE OR ON AUTOPILOT?

Myers and Stauffer can assist with implementing an inpatient DRG prospective payment system, moving away from an outdated grouper version or preparing annual updates to your current DRG system. We have developed tools that make these processes transparent and reviewable so stakeholders can be assured of the reliability and effects of any changes.

In addition, many changes impacting hospital reimbursement programs are being implemented at the federal level and states need to be prepared to evaluate new innovative Medicaid reimbursement strategies in order to bring outdated hospital reimbursement systems to the next level, including performance-based measures, pay-for-performance strategies and outpatient prospective payment systems.

Myers and Stauffer is experienced and ready to update your hospital reimbursement programs with the necessary framework to take advantage of the Medicare national hospital value-based purchasing (VBP) program and readmission penalty program, the Healthcare Effectiveness Data and Information Set (HEDIS) and the move to ICD-10 coding.

Myers and Stauffer provides qualified staff to transition outpatient hospital reimbursement programs. With the adoption of DRGs, hospitals began cost shifting to the outpatient programs. Early state adopters of outpatient prospective payment systems (OPPS) have shown that the same benefits associated with the implementation of inpatient prospective payment systems based on DRGs can be realized with OPPS (e.g., cost containment, improved budget projections). Myers and Stauffer can assist with the move from charge-based reimbursement systems to Medicare ambulatory payment classifications (APCs) or 3M-HIS’s enhanced ambulatory patient groupings (EAPGs)

Myers and Stauffer offers a full spectrum of hospital reimbursement services including:

  • DRG system implementation.
  • Hospital base rates and DRG weight updates.
  • Review and modify reimbursement processes.
  • Solutions for growing medical education and outlier payments.
  • APC/EAPG system implementation.
  • Upper payment limit determinations.

 

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Myers and Stauffer understands your challenges because this is all we do.