MedPay®

 

The MedPay® software is the longest serving Fee For Service (FFS) software currently in use in Australia. Continually developed for over 14 years MedPay® uses over 7500 edits per fee for service billing according to complex CMBS rules which apply to billing. 

 

The MedPay® software is the only FFS software to be tabled in the Victorian Auditor General’s report to Parliament as being recommended for use within all Victorian FFS paying Hospitals.  It is universally applauded for its accuracy and ease of use by financial officers and is incredibly stable due to the lengthy development process it has undergone.

 

The nature of FFS payments and associated entitlement rules is too complex to be performed manually.  Automating the fee calculations significantly reduces the incidence of inadvertent under payment and over payment while enabling statistical and other forms of analysis.

 

 Custom Fee Tables

Hospitals have a choice of applying 100% CMBS or any percentage variation and/or fixed amount decrease or increase on CMBS. Unique items with unique dollar values can be added to any custom fee Table and applied to any one individual doctor.

 

 Derived fee calculations

All CMBS derived fee calculations are automated, including step down percentage calculations for surgery and CMBS anaesthetics. The complex assistance at surgery and radiotherapy derived fees are automated and include application of specific entitlement rules.

 

For consults the questionable practice of manually entering the number of patients seen during a visit is avoided.  MedPay® detects the number of patients seen and calculates the correct fee. If a late claim is submitted (alters the number of patients seen) then MedPay® provides automatic adjustment of the prior payment. Work that is not normally performed under manual systems as it is too tedious.

 

 Inbuilt Report Writer - Creating Transparency in Physician Billing

 

Interfacing to the main system is straight forward and Hospitals can extract data for their own analysis reporting. The MedPay® report writer is also used to match the format of incoming data and to specify the output format.

 

While most reporting requirements have been predicted and are provided in the MedPay® reporting facility, Hospitals can still design their own analysis requirements.

 

MedPay® when combined with DRG Manager provides complete transparency of physician / surgeon billing and practice in terms of fee for service costs within a given DRG. Analysis of Individual Provider “performance” in terms of length of stay and resource utilization (FFS cost) is possible within a given DRG or range of DRG’s. This information can be drilled down and compared across hospitals or within a single hospital with other providers delivering services within the same DRG range.

 

MedPay® in providing transparent billing and performance data allows Physicians and Administrators to set targets for improvements in length of stay which can be matched by increased Physician / Surgeon reimbursement for productivity gains.