Typical Next Wave Project Examples:
- Assist with development and facilitate implementation of both ICD-9-CM codes and Diagnosis Related Group (DRG) categories to assist hospitals to obtain equitable reimbursement (11 NYS and federal DRGs are the result of our work)
- Develop and implement both Medicare and Medicaid Compliance Plans for several Health Information Management (Medical Records) departments
- Conduct Reimbursement, Case Mix, and Rate Analysis audits
- Conduct Patient Care Time Studies for several clients to analyze staff productivity and the potential for work force redeployment. These studies focused on determining patients' needs using several patient classification tools to help our clients evaluate their populations' case mix and appropriate staffing levels
- Evaluate potential case mix systems for Rehabilitation (MDS-PAC, CMGs / RIC / FIM).
- Evaluate potential case mix systems for Home Care (OASIS, HHRGs).
- Use case mix and clinical data to support Managed Care / Provider contracting and Medical Necessity determination at both the plan and provider level.
- Prepare both hospitals and physicians for Medicare Ambulatory Patient Categories (APCs), and demonstrate how they can properly document their services for Medicare / Medicaid Compliance.
- Design, implement, and evaluate quality measures and processes, including audit of quality and documentation of source data.
- Evaluate published "Quality Rankings" and other benchmark indicators and determine appropriateness. Facilitate operational and clinical solutions for confirmed quality concerns and/or facilitate correction of methodological or data inconsistencies.
- Perform Longitudinal Quality Assessment and Documentation Reviews for individual providers to assess whether appropriate care was being delivered and to identify any potential payment problems.
- Assist with development of both the procedure codes and Diagnosis Related Group (DRG) categories to assist hospitals and medical device manufacturers to obtain proper reimbursement. This work resulted in the development by HCFA of Medicare DRGs 491 and 495 through 503
- Negotiated Rate Support Which Includes Risk Assessment, Sensitivity Analysis and Billing Systems Review.
- Perform Focused Medical Records Coding Reviews for Both Compliance and Payment Review.
- Customized Training and Education in any of the above topics.
Partial List of Clients:
- Amsterdam Memorial Hospital
- Columbia Presbyterian Hospital
- Community General Hospital of Greater Syracuse
- Corning Hospital
- Ellis Hospital
- Hospital for Special Surgery
- Mary Imogene Bassett Hospital
- Mt. Sinai Hospital
- New York-Presbyterian Hospitals
- Park Ridge Hospital
- St. Mary's Hospital
- Lung Transplant Centers across the US
- Healthcare Association of NYS (HANYS)
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