HH PRICERActive Reimbursement Components

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HH PRICERActive™ 2-Year Reimbursement DLL

The Home Health (HH) Prospective Payment System is the primary reimbursement methodology for home health claims paid by Medicare. Home Health Resources Groups (HHRGs), represented by HIPPS coding on claims, are the basis of payment for each episode; HHRGs are produced through publicly available Grouper software that determines the appropriate HHRG when results of comprehensive assessments of the beneficiary are input. The HH PRICERActive.Net™ Reimbursement DLL takes in the HHRG code and the data about the services provided during the episode and calculates the standard home health reimbursement for both RAPs and claims according to CMS specifications. Special reimbursement situations for low utilization payment adjustments (LUPA) and partial episode payments (PEP) are also processed by the DLL.

The HH PRICERActive.Net™ Reimbursement DLL duplicates the calculations used by Medicare for calculating the standard HH reimbursement for the HHRG code. HH PRICERActive.Net uses the same formulas and Medicare hospital-specific data that the Medicare contractors use to calculate claim payments. By simply referencing the HH PRICERActive.Net Reimbursement DLL within your application, setting the input property values, and executing the PricerCalc method you can calculate an estimated Medicare payment for any home health agency in the U.S.

Availability:

The HH PRICERActive.Net™ Reimbursement DLL interfaces directly with all .Net capable systems (32-bit or 64-bit) and provides two fiscal years of HH PPS reimbursement calculation functionality. This product utilizes Microsoft SQL Server components for high-performance in large-scale enterprise and web-based applications.

Features include:

HH PRICERActive.Net™ Reimbursement DLL calculates the standard home health reimbursement for both RAPs and claims according to CMS specifications. The software performs the following functions when processing a case:

  •  Calculate RAP payment for the first episode in a series of episodes
  •  Calculate RAP payment for a subsequent episode in a series of episodes
  •  Calculate Final Payment for the first episode in a series of episodes
  •  Calculate Final Payment for a subsequent episode in a series of episodes
  •  Calculate LUPA RAP reimbursement with add-on for the first episode in a series with 4 or less visits where the From date equals the Admit date
  •  Calculate LUPA RAP reimbursement without add-on for a subsequent episode in a series with 4 or less visits where the From date not equal the Admit date
  •  Calculate Partial Episode Payments (PEP) when a patient has been transferred to another HHA or discharged and readmitted to home care within the same 60-day period.
  • Data from the treatment authorization code will be used to re-group the HHRG code for the episode, if necessary

Compatible with the leading Windows development environments including:

  • Microsoft Visual Studio (32-bit or 64-bit)

Licensing:

HH PRICERActive.Net™ components are licensed based upon usage.

For a single site installation, like a health plan, hospital, or university, the HH PRICERActive.Net™ is licensed for internal use based on the size of the installation.

For a Software Developer including HH PRICERActive.Net™ in a software package for distribution to an end user, a distribution agreement is required. Terms: an initial license fee and a per-site fee for HH PRICERActive.Net™.

Send e-mail to salesinfo@microdynmed.com or call for more information and pricing.