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Estimating Tool
CorrectHM provides an up front estimate on all out-patient services (where the provider is contracted
at Medicare rates) at the point of scheduling. Based upon the specialty,and type of procedure that is due
to be performed, we can predict which Medicare billing codes will be submitted on the claim and we can
provide you with the best possible estimates after admitting. Our staff will call the provider to find out
the admitting diagnosis, and probably treatment program to identify which claims we will receive. Once we
have the admitting diagnosis, we can predict the final DRG and therefore the bill amount.
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We also identify what other services were utilized such as anesthesia, surgery, ambulance, and professional providers that
treated the inmate. Subsequently, we follow up with the provider every two days until the inmate is discharged to see if
there are any complicating conditions thatmay affect the final DRG, or if Medicare may authorie outliers.
This allows for us to provide customers with an accrual report, which can be viewed in our patient management
system, to identify accrued amounts to be posted each month.
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