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DSH Mgmt Solutions, LLC (DMS)
provides services for public and private acute care and rehabilitation hospitals to
maximize their Federal and State Disproportionate Share (“DSH”) revenue
and to qualify or retain/re-instate hospital entitlement to the 340B
Pharmaceutical pricing program. MDSS®, our proprietary software system,
makes heavy use of EDI transaction sets, regulatory based logic, UnivEligHicanDb©,
State Data Exchange (SDX) Files with clinical profiling and Medical Group
admission tracking. DMS utilizes a multi-faceted approach with surrounding and
seasonal state level data feeds, retrospective eligibility and with specific expertise
on appeal package development and representation with CMS for the SSI ratio. We offer
full cycle DSH revenue management by integrating prospective and concurrent DSH/340B
management capabilities that allow hospitals to improve management oversight of
these critical sources of funding.
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DSH Management Consulting Services:
DMS consulting services include:
- Client-specific MDSS® system deployment and operation
- Medicaid and SSI Medicare DSH appeal package development and representation
- 340B Pharmaceutical pricing program eligibility maintenance/re-instatement
- CMS negotiation and settlement
- Fiscal Intermediary negotiation and settlement
- Expert witness testimony
- Title XIX supplemental revenue enhancement
- SSI/Medicaid membership management
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DSH Management Software Suite:
Underlying our service capabilities is our proprietary, industry-leading MDSS® DSH/340B management software suite. Our system
integrates
current and historical, summary and detail claims, remittance, eligibility, entitlement and state-wide admission data/guidelines from:
- Hospital’s demographic, clinical, revenue code, payer, physician and CDM data
- Medicare’s LDS MedPar Files, EDI remittance and eligibility files, PS R data files
- Medicaid’s EDI remittance and eligibility files, PS&R data; Title XVI crossover data
- SSA clinical guidelines for disability classification
- State-wide public discharge databases with UPIN data
- MGMS© database linking physicians to Medical groups
- Mandated benefit coverage rules-based tables for Medicare and Medicaid
Our remote, hosted 128 bit SSL secure system serves as the basis for varying levels of client defined outsourced DSH revenue cycle management engagements.
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