Why MedCom
Solutions?

MedSoft Systems

Founded as MedSoft Systems & developed pricing software: Strategic Hospital Pricing (SHP).

First Client

Hamot Medical, a 500-bed hospital located in Erie PA, became MedSoft’s first client to license SHP software.

Comprehensive Budget Software

MedCom licensed SHP software to a national hospital management firm Quorum Healthcare.

MedCom developed an adjacent software product, Comprehensive Budget System (CBS), that imports current financial data used to forecast volume, pricing, expenses, and reimbursement for the next fiscal year. Included is the HCFA 2552 Cost Report stepdown workpaper that calculates Medicare reimbursement.

Medsoft Systems assigned its assets to MedCom Solutions due to common usage of MedSoft for many new entrepreneurial firms that are developing   throughout the United States.

MedCom Solutions was incorporated on October 2, 1989.

Minimum Data Set

First firm in the US to create software that captures the necessary data for a new reimbursement methodology: Minimum Data Set (MDS).

Chargemaster Management

The complex nature of the healthcare industry and regulatory agencies have substantial influence on the chargemaster.

MedCom began to provide consulting services for chargemaster management review for CPT codes, revenue codes and general ledger mapping.

3-Day Window Compliance Software

MedCom was approached by a large hospital to assist with a Department of Justice (DOJ) fraud investigation.

Negotiations between the hospital and the DOJ were predicated on Medicare’s 72 Hour Rule. MedCom developed a Medicare compliance software product that reads Medicare’s 835 Remittance Advice to determine if any outpatients were paid within the 3-day rule.

OIG-72 Compliance Audit Software was designed to take advantage of the immunity provision included in Section 8(b) of the DOJ settlement package. This was developed to protect the hospital from further fines and penalties.

Medicare Cash Auditor

Allegheny General Hospital approached MedCom to develop a Medicare payment audit software product that measures actual cash amounts received by fiscal year and by HCFA-2552 Cost Report reimbursement classification. The 835 Remittance Auditor software was used to reconcile every daily 835 payment file to the penny of the actual cash deposit to the hospitals bank account.

Most importantly, the Remittance Auditor uncovered episodes where Medicare had double counted the cash received. Consequently, reconciliation of each fiscal year cost report for the hospital was accurately accounted for on the “To/From” final accounting.

Strategic Pricing

MedCom provided a total pricing review for a large academic medical center. MedCom used Strategic Hospital Pricing to conduct the review revealing a $200 million net revenue improvement.

Clinical Charging

MedCom began to audit IT system integration of order entry connectivity to chargemaster charges. MedCom uncovered that 21 order entry systems at a large academic medical center had charge capture failures.

After one year of manually auditing and correcting the charging issues, the hospital pickup exceeded $250 million in net revenues.

An example occurred where the professional anesthesiology reimbursement was shorted over $30 million due to a yes/no toggle set to “no”. Its setting would not allow for more than one volume to be processed for each of the 15-minute billing increments, regardless of the actual volume of time increments.

CMNavigator® Software

An Urban Academic Medical Center, with professional and technical chargemasters each exceeding 75,000 lines, petitioned MedCom to develop a software product to control and approve all chargemaster requests vis-à-vis its Pittsburgh headquarters.

MedCom developed a base Chargemaster Management Navigator (CMN) and controlled the client’s chargemasters for the next 5 years with continuous improvement and accuracy of patient claims.

Over the course of five years the contractual allowances decreased from 62% to 48% while gross revenue increase by $2.0 billion.

Foreign Chargemaster Build

MedCom was asked to work with Cleveland Clinic’s joint venture for a hospital being constructed in Saudi Arabia. The International Medical Center needed to have the chargemaster built from the ground up. MedCom went onsite and developed the chargemaster in two months.

Medical Necessity Problem

A Pittsburgh urban teaching hospital was incurring patient claim denials for lack of medical necessity. MedCom developed a software product, ABN Crosswalk. It was designed to be used by the registration staff that reads in the ICD-9/ICD-10 diagnosis code and crosswalks it to the CPT/HCPCS codes to determine if the diagnosis supports the services about to be performed. If the procedure is not supported by the diagnosis, the patient is asked to sign an Advanced Beneficiary Notice, (ABN).

Alternatively, when ABN Crosswalk alerted the registration staff of a medical necessity problem, the staff would call the physicians office to determine if the initial diagnosis codes were incorrect. If it was determined that they were, an alternative code would be provided.

Within three months, medical necessity claim denials were reduced by over 80%.

Groups & Ranks

MedCom developed a means of classifying medical procedures by clinical families that identify resource value of one procedure to the other.

The Groups & Ranks file was used to manage chargemaster pricing to appropriately scale charges in order of resource value for appropriately tiered pricing.

Merger & Acquisitions

A large national healthcare system requested assistance with  merging a newly purchased hospital’s chargemaster to the corporate standard chargemaster.

MedCom successfully utilized its C³ Software to accurately merge the acquired hospital system into the corporate standard chargemaster.

Surgical Standardization

A large national healthcare system requested that MedCom align the Operating Room Surgical time charges on a national basis. It was to be congruent regardless of the hospital where a patient is seen. Surgery time charges are found to be both inconsistent and correspondingly suffer from underpayments.

MedCom developed a process that provided uniform charge alignment for all 60 hospitals. It was reported that an average increase to net revenue exceeded $1,000,000 per hospital.

Payment & Denial Management

Using the 835 Medicare payment file from all payors, MedCom developed a reporting product called RANavigator™ to identify where payment failures occur.

This reporting package was developed to classify denials for C-Suite reporting. Most importantly, RA Navigator provides the C Suite with a “birds-eye” view of the progress to reduce the volume of denials as an independent, clear view for non-PFS executives.

Link Item Master & Chargemaster

Developed a new workflow utilizing CMNavigator that gives material management staff the ability to concurrently input new items into the material management system and the chargemaster providing a true link between the Item Master and the Chargemaster.

Surgical Classification

MedCom discovered, while working with a large New York hospital system, that it was incorrectly charging surgical services. It was found that 85% of all surgery was classified as level 2 of 6 different levels, causing revenue shortfalls for higher acuity surgical cases.

In response, MedCom invented a means of distributing surgical cases on an acuity measurement over the six surgery levels that is more accurate for services provided. After actual implementation, the hospital generated over $5,000,000 of additional net revenue.