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Retrospective Title XIX Federal DSH Settlement Analysis/Re-filing

With the advent of HCFA 97-2 and recent CMS guidance and State Medicaid program guidance, Title XIX eligibility records must be maintained indefinitely, or until the completion of all litigation on related issues. As a result, a window of opportunity has opened up to facilities who have not realized the full potential of Title XIX eligibility data driven computation of the Medicaid days DSH component proxy. We are confident that our proprietary, industry leading MDSS® application, which goes far beyond the mere matching of a single instance of Title XIX eligibility data will deliver significant and material financial directly accretive financial results for our clients. We will structure our engagement with any potential client, depending on where you are in the process, to reflect our position that our heavily data intensive and fuzzy logic driven application will deliver superior results.

Retrospective SSI Federal DSH Settlement Analysis/Re-filing

The veritable CMS “black box” SSI ratio has finally been pierced (see March 17, 2006 PRRB Baystate ruling) and CMS is on record as having stipulated (Oakwood ruling) that the prior summary value provided to an acute care facility excluded certain claims and days that should have been included in the SSI ratio. MDSS® has developed the capability to analyze, integrate and identify logical anomalies the MedPar Limited Data Sets, both current and prior years, with the Title XIX eligibility datasets that contain associated federal entitlement programs status codes and effective dates. We already have in place the capabilities to identify non-cash federal entitlement program recipients and those with retroactive dates of initial or re-started benefit coverage. In the aggregate, we provide an irrefutable case on behalf of the provider that the summary level SSI ratio previously provided by CMS contains multiple systemic errors and precisely quantify the financial impact of these improperly deflated statistics.

SSI Member Management

SSI Member Management (SSIMM) is a key competitive advantage and strategic 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 take control of this integral component of the Federal DSH/340b calculation provides a compelling and material return on investment for taking 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 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.

Concurrent DSH Revenue Management

In the most recent fiscal year of one of DMS’s hospital clients, the implementation of the MDSS® Concurrent DSH Revenue review sub-system, in conjunction with the periodic update of Title XIX eligibility data, identified 400 plus hospital accounts, within the 12 month Medicaid billing period, that had been coded as either “Self-Pay” or “Charity Care” that, in fact, had received post-discharge, retroactive eligibility for both categorically and medically needy aid categories. This new functionality not only enabled our client to include these days in their “as-filed” Medicare cost report, for DSH Revenue purposes, but also provided the opportunity to receive directly accretive fee-for-service reimbursement for these accounts in excess of $800,000.

Community Benefit Services

It is often the most financially and medically needy segment of our population who would derive the most relative benefit from assistance in navigating the difficult bureaucratic maze to quality and maintain eligibility and entitlement to Medicaid and SSI. DMS’s continually growing Title XVI/Title XVIII database, in combination with the 200 million plus hospital and Title XIX eligibility and status records can not only identify those recipients who have recently lost eligibility/entitlement to one or both of these programs, for potentially reversible reasons, but can also prospectively identify candidates who could be eligible/entitled to Title XIX/Title XVI programs. MDSS® can deliver periodic reports to the hospital’s social services department, or selected 3rd party contractor for follow-up internally or externally to ensure that these “safety net” patients receive the financial/medical assistance to which they are entitled.

Title XIX Supplemental Revenue Enhancement

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