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
HIMCO
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