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. The Patient-Driven Groupings Model (PDGM), using the PDGM HIPPS code on a claim, is the basis of payment for each episode. PDGM codes are produced through publicly available Grouper software that determines the appropriate PDGM code when results of comprehensive assessments of the beneficiary are input. The HH PRICERActive.Net™ Reimbursement DLL takes in the PDGM 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 home health PPS 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 PDGM code. HH PRICERActive.Net uses the same formulas and Medicare agency-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 .Net capable systems 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:

• Calculates Final Payment for the first episode or for a subsequent episode in a series of episodes
• Calculates LUPA reimbursement based on the PDGM acode and the number of visits.
• Calculates Partial Episode Payments (PEP) when a patient has been transferred to another HHA or discharged and readmitted to home care within the same period.
• Calculates an outlier amount for high utilization of services if applicable

Compatible with the leading Windows development environments including:

• Microsoft Visual Studio
• Microsoft .Net Core (.Net, 6, 7, 8)
• Microsoft .Net Framework 4.6.2+
• Microsoft SQL Server

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 sales@microdynmedical.com or call for more information and pricing.