Medicare Disproportionate Share System (MDSS®)

MDSS® is the flagship product of DMS and serves as the cornerstone of virtually all services we offer to clients, whether it be retrospective recovery of Medicaid or SSI DSH revenue, concurrent recognition of supplemental fee-for-service billing opportunities, or prospective management of Federal and State DSH revenue streams

Medicare Disproportionate Share System (MDSS®)

There are eight major sub-systems within MDSS® as can be seen in the main GUI interface option which is available as one option for navigation of the system. These sub-systems include the following:

DSH Inpatient Days:

DSH Inpatient days is the heart of the MDSS application and integrates information/data from the hospital, Medicaid and Medicare, the Social Security Administration, State-wide public discharge databases and the proprietary MGMS (Medical Group Management System). The DSH Inpatient Days view ranges from hospital/system year perspective, to single line per claim, to patient/member and all the way down to claim level.

Financial subsystem

The Financial subsystem provides precise, non-speculative projections of the financial impact for each retrospective Title XIX and Title XVI/XVIII analysis. The DSH payment owed for single or multiple years for a single hospital or hospital system can be modeled based on calculations within MDSS that accurately reflect the CMS regulations then in force and either the “as-filed” or latest NPR hospital cost report variables required for entry in the system. From the single hospital, one or multiple year view, the user can be directed to the Detail view for each component of the DSH calculation, and then subsequently drill down to patient/member or claim level and audit (and either confirm, deny, partially deny or pend all or a portion of the claims that comprise the financial variance analysis.

Help / Users Manual / Tutorial

DMS provides a fully functional and integrated user manual/help system/tutorial system to enable the end-users to operate all or any portion of the MDSS. Error reporting is built into the system along with screen capture software to provide a static look at the error message and application portion relevant to the sys abend.

Auditing:

The Auditing function serves both internal and external users of MDSS. Any claim, at any time can be audited and categorized into one of several groups. Reporting can be audit project specific or based on the category assigned to all claims audited. Audit project criteria include dataset selected, year, facility and type of day. Random selection of claims is an option as is a specific listing of claims identified by any user. Should "hard copy" documentation be required to close the loop to fully verify any number of claims, the system already has an integrated scanning function to link up a digitized version of the document.

Quality Assurance:

Data quality is integral to everything we do at DMS. We provide feedback to all involved parties on data quality issues like invalid SSN's, invalid Medicaid recipient numbers, missing SSI claims from the CMS former "black box" summary numbers provided; missing Federal or State Title XIX mandated eligibility records.

Query Management

The Query Management subsystem allows user to define, refine and execute custom queries on a large number of important data elements and distinct data sets in the system; results can be customized from a data element inclusion perspective and logical operands.

Application Management

MDSS is designed to allow the user to operate the entire system with minimal assistance fro DMS and, as such provides the capability for user-defined, as well as pre-defined import and export data sets. DMS also offers the capability to handle the entire DSH Revenue Management cycle on an outsourced basis.

Prospective Management

Prospective management functions within MDSS are currently segmented into three parts; community benefits which identifies potential SSI recipients, by financial class, who are not currently receiving Federal financial aid; a patient/member diagnosis clinical history and filter that identifies which members meet the SSA clinical requirements for disability; and a Market share management sub-system that use the proprietary MGMSTM and State-wide inpatient discharge data to provide the user the ability to track internal and external medical group facility utilization patterns.