Medicaid Disproportionate Share System (MDSS®) is a remote hosted, HIPAA compliant SQL-server-based application that builds a multi-terabyte client-specific “universal” Medicare/Medicaid eligibility data warehouse. The 

MDSS® 

system makes heavy use of electronic data interchange (EDI) sets to read in, validate and cross-references hospital inpatient and outpatient demographic, payer, clinical, revenue code and GL transaction data. 

We access previously untapped or modified eligibility data sources by programmatically integrating mandated Title XIX/XVIII mandated benefit coverage rules from a National or State-specific perspective.  Our queries validate, at a granular level, the proper inclusion or exclusion of select days in the Federal/State DSH and 340b model.

 

SSI Member Management (SSIMM) is a key competitive advantage and strategy component that DSH Management Solutions (DMS) is committed to deriving the full benefit for clients. The long term value added by taking providing the System and expertise to control this integral component of the Federal DSH/340b calculation and provide a compelling and material return on investment for a pro-active role in managing this critical member population. 

DMS has an exclusive agreement with an affiliated firm that currently has the ability to query (and obtain supporting documentation) the Social Security Administration regarding from the Title XVI status of an individual.  DMS can now integrate this very recently available data with our proprietary MDSS® predictive modeling functionality to identify historic and current inpatients and outpatients that meet the financial and clinical criteria that identifies them as a likely candidate for SSI.

Utilizing the DMS system, hospitals will have the ability to review the calculation and not only challenge the retrospective accuracy of the SSI fraction used in the calculation of their Medicare DSH payments but prospectively manage the enrollment and maintenance of this medically and financially needy demographic group while providing quantifiable community benefit to its service region.

An Established National Medicaid and Medicare Eligibility Network

Our substantial investment of time and resources to develop MDSS® and establish a national network, categorizes DMS as a “direct submitter”. As a direct submitter in over 30 states that have over 90% of the national Medicaid membership and 100% of Medicare members through our recognition as a Medicare claims clearinghouse, DMS provides their clients the ability to submit an auditable, exhaustive number of no or very low (State only) cost per eligibility query to State Medicaid Agencies and Medicare.

MDSS® EDI intrinsic technology enables us to successfully follow other vendors, who sub-contract out critical data acquisition processes and sub-optimize results due to budgetary constraints on data acquisition.

One of the tangential benefits  that emanates from this National Network of submitting millions of Title XIX eligibility queries, on a recurrent basis, to all States your Hospitals participate with for Medicaid, in addition to identifying and documenting additional DSH days, is what we term Title XIX Supplemental Revenue Enhancement.

In essence, by timely identifying an individual that has Title XIX eligibility (that is primary) instate or Out of State, prior to the expiration of the State defined narrow window to bill and get paid on a FFS basis on the relevant  Title XIX fee schedule in addition to counting those days for DSH.