APR-DRG PRICER

On July 1, 2013 California’s Medicaid Program (Medi-Cal) changed its reimbursement to hospitals to APR-DRG methodology. Our pricer allows hospitals/payors to identify their expected payment under this methodology.

 

 
Problem   Solution

  • Most hospitals are not familiar with Medi-Cal’s new APR-DRG reimbursement and do not have the systems in place to accurately calculate expected payment for these claims.

  • It often takes a few months for the IT department and system vendors to set up and validate calculations.

  • Hospitals need a way to validate that the base rates given to them by DHCS are justified.

  • CFO’s need to a way to calculate the contractual allowances for monthly financial statements.
  • Med-Cal offers a pricer which only prices one claim at a time. This can be too time consuming.
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    BinderOne can help guide your facility to a smooth transition into Medi-Cal’s APR-DRG payments.  We will work your staff to set up a batch process of your Med-Cal data.  We leverage our expertise in data migration, analysis, and hospital reimbursement to quickly get your facility ready. Given the complexity of the calculations which involve transfer proration, LOS thresholds, outliers, cost ratios, we can serve as a validation source for a facility that currently has a system in place. Contact us for more detailed explanation of our system and process.