Payors, Insurers, and Attorneys

Typical Next Wave Project Examples:

  • Implement of the nursing home PPS (RUG II for Medicaid in several states and RUGS III) and evaluating that implementation at both the organization and regulatory levels
  • Evaluated numerous Quality and Report Card Measurement systems to determine their effect on HMO rankings
  • Use case mix and clinical data to support Managed Care / Provider contracting and Medical Necessity determination at the plan level
  • Negotiated Rate support which includes risk assessment, sensitivity analysis and billing systems review
  • Assess the impact of the New York State Case Payment System on the New York State health maintenance organizations (HMOs) for the New York State HMO Conference (NYSHMOC), on both a global and individual rate component basis
  • Evaluate the implementation of case mix reimbursement on nursing homes over a ten-year time period for the New York State Department of Health. This study identified "Best Practice Success Strategies" for facility management.
  • Case Documentation Due Diligence
  • Customized Training and Education in any of the above topics
Partial List of Clients:

  • Blue Cross/Blue Shield of Rochester
  • Brindisi, Murad, Brindisi-Pearlman, LLP
  • New York State Department of Health – Medicaid
  • NYS Health Maintenance Organization Conference (NYSHMOC)
  • Preferred Care
  • Proskauer, Rose, LLP
  • State of North Dakota Department of Health – Medicaid
  • State of Washington -Aging and Adult Services – Medicaid