Psych PRICERActive Reimbursement Components

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Psych PRICERActive™ 2-Year Reimbursement DLL

The Inpatient Psych Facility (IPF) Prospective Payment System is the primary reimbursement methodology for inpatient psychiatric facility claims paid by Medicare. The Medicare, Medicaid, and SCHIP, Balanced Budget Refinement Act of 1999 (BBRA)(Pub.L. 106-113, Section 124), directed the development of a per diem PPS for inpatient psychiatric services furnished in psychiatric hospitals and psychiatric units of acute care hospitals and critical access hospitals. The major requirements are a per diem payment amount, an "adequate patient classification system that reflects the differences in patient resource use and costs among such hospitals", and budget neutrality in the first year of implementation. An adequate classification system would result in the appropriate targeting of greater prospective payments to providers treating more costly resource intensive patients using statistically objective criteria. The law also required that the Secretary submit a report to Congress describing the system, and directed implementation of the inpatient psychiatric PPS effective for cost reporting periods beginning on or after October 1, 2002.

The IPF PPS calculates a standardized federal per diem payment rate to be paid to all IPFs based on the sum of the national average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. The federal per diem payment rate is adjusted to reflect certain patient and facility characteristics that were associated with statistically significant cost differences. IPF PPS provides patient-level adjustments for age, specified medical severity diagnosis-related groups (MS-DRGs), and selected comorbidity categories. It also provides facility adjustments that include a wage index adjustment, rural location adjustment, a teaching status adjustment, an adjustment for the presence of a qualifying emergency department, and a Cost-of-Living Adjustment for IPFs in Alaska or Hawaii. IPF PPS also includes payment for extraordinarily high cost patients through an outlier policy. It also includes an interrupted stay policy and an additional payment for each electroconvulsive therapy (ECT) treatment.

The Psych PRICERActive.Net™ Reimbursement DLL duplicates the calculations used by Medicare for calculating the standard inpatient psych reimbursement based on the DRG for the claim. Psych PRICERActive.Net uses the same formulas and Medicare facility-specific data that the Medicare contractors use to calculate claim payments. By simply referencing the Psych 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 inpatient psych facility in the U.S.

Availability:

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

Features include:

Psych PRICERActive.Net™ Reimbursement DLL calculates the IPF PPS reimbursement according to CMS specifications. The software performs the following functions when processing a case:

  •  Calculates a standardized federal per diem payment rate
  •  Calculates patient-level adjustments for
    • Age
    • Specified MS-DRGs
    • Comorbidity categories
  •  Calculates facility-level adjustments that include:
    • Wage index adjustment
    • Rural Location Adjustment
    • Teaching status adjustment
    • Adjustment for presence of a qualifying emergency department
  • Includes application of interrupted stay policy
  • Calculates an additional payment for electroconvulsive (ECT) treatment
  • Calculates an outlier payment for extraordinarily high-cost patients

Compatible with the leading Windows development environments including:

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

Licensing:

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

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

For a Software Developer including Psych 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 Psych PRICERActive.Net™.

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