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Leslie Bonacum
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Neil Allen
847-267-2179
neil.allen@wolterskluwer.com

CCH Reimbursement Toolkit Calculates, Documents, Medicare Payments

(RIVERWOODS, ILL., April 11, 2005) – Now there’s a simple way for professionals dealing with Medicare to determine and document a wide range of reimbursement types with a toolkit of calculators from CCH INCORPORATED (CCH), a leading provider of health care law information and software and a Wolters Kluwer company (health.cch.com).

The CCH Reimbursement Toolkit provides seven separate calculators, accessed via the internet, to determine whether a case qualifies for outlier payment and the amount of any outlier payment that may apply. The Toolkit also links directly to related laws, regulations and final rules, so you can examine the rationale behind the calculations. In addition, reports of each calculation are generated with the ability to save, print or email. Designed to assist health care reimbursement professionals with forecasting their Medicare reimbursement from CMS, the CCH Reimbursement Toolkit offers the ultimate cost-effective way to supplement or audit expensive contract management tools and billing systems.

The Toolkit calculators are a time-saving alternative to ‘home-grown’ Excel spreadsheets, and unlike other calculators available on the web, they’re updated by CCH on an as-needed basis, so users enjoy peace of mind knowing they’re using current data.

Calculator Capabilities

The CCH Reimbursement Toolkit contains specialized calculators for inpatient prospective fees, physician fees, inpatient psychiatric facilities, skilled nursing facilities, inpatient rehabilitation facilities, outpatient facilities and long-term care hospitals.

The Inpatient Prospective Payment System Calculator determines:

  • The hospital-specific DRG payment rate for the beneficiary’s case;
  • Whether or not the beneficiary’s case qualifies for an outlier payment; and
  • If the case qualifies for an outlier payment, what the outlier payment will be.

The Physician Fee Schedule Calculator determines:

  • The Medicare payment amount under the Physician Fee Schedule (80% of the lesser of the doctor’s actual charge or the fee schedule amount);
  • A service’s eligibility for the Health Professional Shortage Area Bonus; and
  • For calendar year 2005, a service’s eligibility for the Physician Scarcity Area Bonus.

The IPF Prospective Payment System Calculator determines:

  • The hospital-specific DRG payment rate for the beneficiary’s case;
  • Whether the beneficiary’s case qualifies for an outlier payment; and
  • If the case qualifies for an outlier payment, what the outlier payment will be.

The Skilled Nursing Facility Prospective Payment System Calculator determines:

  • The SNF’s specific RUG payment rate for each beneficiary’s case;
  • Whether the case qualifies for an adjustment under either the Balanced Budget Refinement Act of 1999 (BBRA) or the Benefits Improvement and Protection Act of 2000 (BIPA); and
  • The payment for the RUG in which the beneficiary is classified if the beneficiary has a diagnosis of AIDS (diagnosis code 042) for services rendered on or after October 1, 2004.

The Inpatient Rehabilitation Facility Prospective Payment System Calculator determines:

  • The IRF-specific payment rate for the beneficiary’s case;
  • Whether the case qualifies for transfer per diem payment; and
  • Whether the case qualifies for an outlier payment, and, if it qualifies, what the outlier payment amount will be.

The Outpatient Prospective Payment System Calculator determines:

  • The hospital-specific payment amount for each HCPCS and APC classification assigned to the beneficiary’s case;
  • Whether the claim for the services provided to the beneficiary qualifies for an outlier payment; and
  • The outlier payment amount should the claim qualify.

The Long-Term Care Hospital Prospective Payment System Calculator determines:

  • The LTCH-specific LTC-DRG payment rate for the beneficiary’s case;
  • Whether the beneficiary’s case qualifies for a high-cost outlier and/or short-stay outlier payment; and
  • The outlier payment should the claim qualify.

Availability and Pricing

For more information or to order call 888-224-7377 or visit health.cch.com. Price of a one-year, standalone subscription is $999 for all seven calculators for up to four concurrent users; $199 for any single standalone calculator. Special pricing is available for adding calculators to existing CCH subscriptions.

About CCH INCORPORATED

CCH INCORPORATED is a leading provider of health care law information and software (health.cch.com). Headquartered in Riverwoods, Ill., CCH was founded in 1913 and has served more than four generations of professionals and their clients. CCH is a Wolters Kluwer company (www.wolterskluwer.com) and, with Aspen Publishers, is part of the Wolters Kluwer Legal unit.

Wolters Kluwer is a leading multinational publisher and information services company. Wolters Kluwer has annual revenues (2004) of €3.3 billion, employs approximately 18,400 people worldwide and maintains operations across Europe, North America and Asia Pacific. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its depositary receipts of shares are quoted on the Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.

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