The DRG/APC Case Mix Management solution provides essential reimbursement tools and vital information on a hospital's case mix, including comparisons between actual costs and reimbursement.

The solution features:

Automatic integration. The DRG/APC Case Mix Management solution eliminates duplication of data by being integrated with HMS's Patient Accounting solution and Health Information Management solutions. All information is entered once and used as needed in other solutions.

A smarter use of resources. The system gives a healthcare team more efficient tools to plan admissions and utilization reviews. For instance, an online DRG grouper that can be used for patients and non-patients can show expected reimbursement.

Optimal reimbursement. When diagnoses are entered on the abstract, the system identifies co-morbidities and complications. And with its continuous DRG monitoring, the system reduces Medicare rejection of claims, which speeds payments and increases cash flow.

Projection tools. By using all of a facility's diagnosis and procedures codes, the system allows a management team to project revenue levels and plan accordingly.

A speedier DRG/APC assignment process. Ensuring that a facility receives fair reimbursement can be difficult and time-consuming. But the system's use of a grouper that automatically assigns the highest allowable DRG/APC makes the process easier and faster.

Enhanced management of cost vs. reimbursement. A system-generated outlier warning report can compute length of stay and cost outliers, automatically flagging potential problems.