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OBJECTIVE:
To determine
whether or not a particular patient referral warrants special individual consideration (IC) by exceeding evolving contractual parameters. Automate the
entire referral process book of business and provide a margin analysis
within hours of initiation.
REQUIREMENT:
Program logic into a system to calculate per diems by calling upon
substantial legacy inventory and other industry-standard medical reference tables, and compare
these results to calculated reimbursements by payer and insurance
product.
RESULTS EXPERIENCED BY CLIENT:
Accurate, timely
documentation of referral data and margin analysis reports resulted in
the elimination of denied claims of this type, and subsequently,
remuneration for all IC requests was negotiated successfully.
DISTINCTIVE
APPLICATION FEATURES:
- Intuitive, centralized
at-a-glance user interface
- Extensive use of drop-down and
lookup/auto-populated fields to expedite record entry and maintain data
integrity
- Temporal centric calendar-based date and time selection
- Designed with HIPAA compliance in mind through use of
industry-standard codes
- Pharmaceutical therapy selection by generic
or brand names
- Built-in, custom
contact manager with claim status
tracking
- Sophisticated per diem calculations and margin analyses
reporting.
INDUSTRY: Medical Management. Home Therapy Services.
OFFICE: Saco, Maine |
Data-Driven
Intra/Internet Applications
