Payment Method Modernization
On this date, a requestor submitted an enhancement for the end user to calculate a contract using the service order rather than the existing calculation.
What occurred on 9/24/2019 during a Business Group Meeting?
It took a director, 3 engineers, and 2 PAs with calls on SAT & SUN to identify a solution.
How do you solve long-running processes for calculations?
We need this data, but we can't pull the data from the Concuity tables and don't know where it is in EDWPF.
What are the Concuity Pricing Factors?
What was established on November 2, 2020, that changed the Medicare IPPS payment method and continues to tweak the logic almost quarterly each year?
What is New COVID-19 Treatments Add-On Payments?
3 Pricing/Payment Methods were excluded from this exercise.
What are Medicare IPPS, Medicare OPPS & Medicare RBRVS?
IP Allo, IP Auto, Car T, BMT, Heart, Liver, Spleen, Pancreas, Kidney, and Lung are used to define this type of service
What are Transplants?
Users are now able to simply copy/paste from an export file to ADS.
How did this process save end users 48 hrs per year?
These modifiers indicate services furnished in whole or by a part of a PTA or OTA are paid at an amount of 85% for Medicare OPPS claims.
What are CQ & CO modifiers used for?
During the grooming of this development request, we accommodated other features that have been deployed.
What are the 29 tickets that were groomed, developed, and deployed that impacted ADS-2018?
Additionally, there are 6 tickets Approved & 22 tickets for Grooming, Contract Priority, or Backlog
The creation of one standard item on each Transplant account saved on average 80 minutes per contract model.
What is the benefit of a Zero Charge Record for Transplant Cases?
This was leveraged early on for a WebApps Solution.
What is Pricing Transparency?
When Diagnosis Code Z00.6 is present on an account for this DRG the weight is adjusted by 0.17
What is MS-DRG 018 Chimeric Antigen Receptor (CAR) T-Cell Immunotherapy?
The following Payment/Pricing Method have one thing in common
EN AP DRG Fee Schedule, EN APG Fee Schedule, EN Chargeability Activity Fee Schedule, EN HCFA DRG Fee Schedule, EN Required Manual Intervention, PD Required Manual Intervention, CI Required Manual Intervention
What is ADS-2264 Remove the following Payment Pricing Methods from the selection.
This person stated on 2/5/2022, "I think the proposed suggestion will work and probably be easier in the long run. Thanks for your guys working last night and today. I know that is a lot for folks to do."
Who is Debbie Steed?
This person said, "I have been able to take the files you provide and vlookup the factors in our IP MCR QA Tool which saves the analyst the time, it would take to manually enter them from the snips."
Who is Lani Hutto?
Paxlovid, Molnupiravir, Veklury, and Remdesivir have one thing in common.
What are COVID-19 Treatment drugs?
After initiating work for several months, it was during what meeting that the established agenda derailed and we focused the next two days on drawing flow charts explaining how each payment method processes an account during the calculation.
What happened during ADS Extended Grooming Session on 2/25/2022? Welcome to the ADS Team for Joe Nixon
This MS-DRG had a calculation change in Medicare IPPS and is also a Transplant DRG.
What is MS-DRG 018 Chimeric Antigen Receptor (CAR) T-Cell Immunotherapy?