PACT Policy
The type of payors that the PACT policy affects
What is Medicare and Medicare Advantage
The 3 main products under the service line
What are Fee for service, managed care or medicare advantage, and shadow billing or IME/GME payments?
the main type of meeting that an associate would need to pull transfer data for
what is a qbr or business review
The person that will have client specific answers to questions when you are building a QBR
The name of the overall ellective service that discharge to home falls under
What is an add on value service?
what a hospital receives instead of a full DRG payment under the PACT policy
What is a per diem or partial DRG payment?
the product that makes up 95% of the transfer solution revenue
What is Fee for service?
the 2 most common discharge status code types that we find
What is 01 and 06 or home health and skilled nursing?
The second type of person if you are looking for data specific answers to questions when building a qbr
Who is the data validation lead?
the type of review that the discharge to home add on service is
what is compliance
The abbreviation for the Centers of Medicare and Medicaid Services
What is CMS?
the time period of the federal fiscal year
what is october through september
the term that signifies the ratio of claims rebilled over the total amount of claims reviewed
What is the rebill percentage?
two types of slides that will always be included in a transfer qbr
what are a service summary page and a FFS trending page
the abbreviation for Discharge to Home
what is DTH?
The decade that CMS decided to implement the PACT policy
What is the 90's?
the type of code R1 recommends the client makes a change to for fee for service and managed care reviews
What is a discharge status code?
the percentage that R1 usually finds of shadow bill opportunities for the client
What is between 0 and 5%
the two most important pieces of information necessary to building a TDRG (or any for that matter) QBR
what is the client name and the date range looking to be covered?
the % of claims that we have found that may be compliance opportunities under the discharge to home service
what is the exception rate?
The number of DRGs eligible for FFY 2025 Discharges
What is 285
The type of review done twice a year looking back at fee for service data for 4 years?
The rebill percentage that would show us a client has a healthy project/is within our benchmarking range
What is between 15-20%
The name of the field that will allow you find the data that we sent results to client
what is the inflowed data filter or the file sent to client date?
the name of the category that a claim would fall into if we found that there was a related home health stay that overlapped with the time period that the patient was at the hospital or acute care facility
What is home health spanning?