The Medicare Disproportionate Share Hospital (DSH) Program is a key source of funding for many providers that serve low-income populations. At NAVEOS, we use our DSH Analytics solutions to help providers maximize their payments.
Over a decade of experience has been coded into our state-of- the-art data analytics software. Our solution automates hundreds of rules, and leverages sophisticated eligibility verification processes to allow us to deliver 2-6% in additional Medicare DSH value, all while maintaining a best-in-class 99% audit accuracy rate. Increased DSH reimbursement improves the bottom line for providers and helps them better serve some of our most vulnerable communities.
Our DSH data analytics suite currently consists of the following products:
Prospective Medicare DSH: We maximize current-year DSH payments by performing extensive data mining to uncover "hidden" eligibility. We don't require providers to install software or go through extensive training. We seamlessly produce a Medicare DSH report that can be easily shared with Medicare Administrative Contractors.
Retrospective Medicare DSH: Our smart analytics can recoup unclaimed value on behalf of providers for non-current hospital fiscal years. By applying our proprietary software solution, we're able to find 2-6% additional value even if other vendors were used in the past. We've processed over 1,000 DSH reports and found over $500 million in value for our clients.
S-10 Data Analytics
The Affordable Care Act mandated that 75% of all Medicare DSH dollars be allocated to an "Uncompensated Care Pool", which will be distributed using Worksheet S-10. We have developed a best-in-class S-10 Data Analytics solution for the S-10 migration that uses sub-claim level data to accurately track and document uncompensated / charity care.
Our software performs sub-claim level analytics and data mining on all electronic claims records to build an accurate, "bottom-up" view of true uncompensated / charity care costs. Competitors that use the "general ledger" approach risk misstating these values, a costly proposition given CMS' increased scrutiny on payments.
Our audit documentation allows providers to keep the dollars they deserve and continue helping those in need.
S-10 Data Analytics: we seamlessly perform sub-claim level data analytics and mining on all electronic claims records to achieve optimal value discovery and documentation of all Uncompensated Care costs. Our bottom-up approach maximizes value while providing best-in- class audit documentation to ensure providers keep the dollars they deserve and can continue helping those in need.
Policy Reviews: our in-house team of experts can assist your hospital in making sure that your policies adhere to the latest federal and state Worksheet S-10 regulations. Additionally, we will offer suggestions on how to position your policies to maximize Uncompensated Care reimbursement levels.
340B Program Data
The 340B Drug Pricing Program offers discounted drugs from drug manufacturers to qualifying providers. We leverage our 340B Analytics to make it easier for providers to attain or maintain program eligibility.
Our 340B and DSH product suites work in concert to help providers reach the required DSH adjustment percentage to attain program status. This typically results in millions of dollars in ongoing, annual savings for our clients. For hospitals at risk of losing eligibility, our data analytics solutions ensure all available eligibility is accurately reported, greatly minimizing the likelihood of losing status.
SSIRD and Medicaid
We're continually working to develop new solutions to help providers maximize their governmental reimbursements. Some of our other data analytics products include:
SSIRD Data Analytics: We perform Supplemental Security Income Re-Determination calculations for "re-openable" cost reports to determine whether it's preferable to use the federal fiscal year over a providers' hospital fiscal year to calculate their SSI Ratio. Our SSIRD Analytics are a great add-on service for hospitals looking to maximize their ROI.
Medicaid DSH Analytics: In addition to our Medicare DSH Analytics, we help hospitals maximize their payments from the state-run Medicaid DSH Program. Using our software, we integrate hospital-specific data with Medicaid Managed Care Organization (MCO) electronic claims data to find additional eligibility and secure program dollars.
Keeping up with changing reimbursement models and new policies is a challenge. Hospitals face pressure to make better use of data and make informed decisions to maximize their reimbursement dollars. Our COMPASS INSIGHT dashboard allows hospitals to easily visualize their DSH, S-10 and 340B reimbursement data so they can better manage costs, reduce risk, and comply with evolving regulations efficiently and effectively.