Government Appropriate Payer Solutions
State Medicaid challenges with Long Term Care spending have increased due to the increase in the service demand, high cost care, and complex billing procedures. Legislation for appropriate Medicare and Medicaid billing drive the need to ensure the integrity of nursing facility payments.
Appropriate Payer – Payment Integrity
DART Chart’s Appropriate Payer Solution provides proprietary algorithms to quickly evaluate dual eligible Medicare payment options. Our online solution works directly with MDS data, incorporates all Medicare payment rules, and occurs pre-payment to avoid pay and chase.
- Reduced Medicaid costs through accurate identification of Medicare benefits for dual eligibles
- Proven accuracy and success through processing over 20 Million Medicare claim days with NO Medicare payment adjustments in 19 years of service
- Automated and comprehensive Medicare eligibility analysis for all qualifying conditions
- Increased Medicare revenue to Nursing Facilities
- Enhanced patient services and outcomes
Watch the video below for an illustration of how the process to enhanced savings works:
Appropriate Payer – Medicaid Compliance
While Medicaid Managed Care programs can limit a state’s exposure to increasing medical costs, there are new challenges and risks for States associated with the long term care and CMS Managed Care rule compliance effective January, 2017:
- MCO Duplication of Services and Payments / Payment Integrity
- Intensive Regulatory Reporting Requirements
- Management of Encounter Data / Capitated Payments
- Potential for Federal Matching (FMAP) Deferral or Disallowance
- Disruption in Efficiency from Implementing All Requirements Simultaneously
Proactive monitoring of LTSS systems in a managed care environment ensures access to necessary services and supports, improves care coordination, and ensures accurate encounter data reporting.
DART Chart’s Appropriate Payer Compliance Solution automates long term care encounter data oversight ensuring accurate capitation rates and MCO compliance without federal matching disruption. The care risk monitoring solution utilizes proprietary algorithms that:
- Compare Incident Rates by Payer
- Evaluate High Risk Frequency and FFS Baseline by MCO
- Monitor MDS Quality Review Initiative
- Provide Best Case Outcomes Reporting for CMS