AR Management
CDM Management
Charge Capture
Contract Management
Credit Balance Automation
Denial Management
Patient Safety and Quality
Underpayment Recovery

Under Healthcare Reform, hospital acquired conditions (HACs) and Patient Safety Indicators (PSIs) will have greater implications on hospital operations. In 2014, Health and Human Services (HHS) will start cutting reimbursement to hospitals with the greatest number of Medicare HACs. According to a 2010 study by HHS, healthcare organizations need to improve how they identify, track and report adverse events to reduce health risks to patients, and to maintain the hospital's financial health. Specifically, the report found that diagnosis codes for almost two-thirds of the Medicare HACs were either missing or incorrect in the billing data. These coding errors also led to inaccuracies associated with PSIs. Secondly, 93 percent of adverse events were not captured in the billing data and went unreported.

MethodCare's Quality and Compliance Solution accurately and automatically detects HACs and PSIs in billing data to maximize hospitals' compliance leading to higher quality patient care, and greater opportunity for reimbursement. In real-time, the Quality and Compliance Solution validates procedural, diagnosis, and charging data against adverse events guidelines. Using MethodCare's solution leads to greater accuracy, streamlined processes and the elimination of the risk of financial penalties for HACs and PSIs. MethodCare's provision of root cause analysis and real time reporting means administrators can now make proactive improvements, thereby mitigating the risk of continued detrimental impact to a patient's health and the hospital's compliance efforts.

MethodCare's Quality and Compliance Solution:

Automatically flags HACs and PSIs
Routes in real-time accounts meeting HAC and PSI criteria
Provides customized workflow to track HACs and PSIs through resolution
Identifies reimbursement impact related to HAC and PSI accounts
Delivers daily tracking and reporting to meet federal mandates
Stores years of HAC and PSI data to report quality and compliance trends

MethodCare's Quality and Compliance Solution seamlessly integrates into our complete suite of revenue cycle solutions, including Charge Capture, Underpayment Recovery, Denial Management, Contract Management, Credit Balance Management, CDM Management, and AR Management.

MethodCare's Solutions are delivered as Software as a Service (SaaS), alleviating hospitals with the burden and cost for hardware, software maintenance, and ongoing operations and support.

http://oig.hhs.gov/oei/reports/oei-06-08-00221.pdf