SNF PRICERActive Reimbursement Components

Request a Free 30-day Trial Version

SNF PRICERActive™ 5-Year Reimbursement DLL

The Skilled Nursing Facility (SNF) Prospective Payment System is the primary reimbursement methodology for skilled nursing facilities (SNFs) and hospitals with a swing bed agreement for claims paid by Medicare. The primary patient classification mechanism, new for FY20, is the Patient-Driven Payment Model (PDPM) that supercedes the older RUGS (Resource Utilization Groups) used through FY19. Resource needs of residents are processed through a complex algorithm to calculate the PDPM code. Associated with each PDPM code are five case-mix adjusted rate components that are driven by patient characteristics. The PDPM code and other hospital-specific and geographic cost factors are the input to the SNF PRICER programs used by Medicare fiscal contractors to compute Medicare reimbursement for a stay.

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

Availability:

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

Features include:

  • Calculation of the SNF PPS reimbursement amount based on the PDPM code for FY20 forward, and the RUGS code for prior years, geographically weighted using the wage index of the provider. Selection of the processing year is based on the thru date of the claim.
  • Application of case-mix adjustment factors for:
    • SNF residents with Acquired Immune Deficiency Syndrome (AIDS)

Compatible with the leading Windows development environments including:

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

Licensing:

SNF PRICERActive™ components are licensed based upon usage.

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

For a Software Developer including SNF PRICERActive™ 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 SNF PRICERActive™.

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