MODEL 1: The Providers participate in all MS-DRGs (Medicare Severity- Diagnosis Related Groups): The Episode of Care is defined as the inpatient stay in the acute care hospital. Medicare pays the hospital a discounted amount based on the payment rate established under the inpatient rates established under the inpatient Prospective Payment System used in the original Medicare program.

MODELS 2, 3 and 4: There are 48 clinical episodes and many subset conditions for the remaining participating providers to choose. Models 2 and Model 3, involve a retrospective bundled payment arrangement where actual expenditure are reconciled against a target price for an episode of care. Model 2, the episode includes the inpatient stay in acute care hospital plus the post-acute care and all related services up to 90 days after hospital discharge.

In MODEL 3, the episode of care is triggered by an acute care hospital stay but begins at initiation of post-acute care services with a Skilled Nursing Facility (SNF), inpatient rehabilitation facility, long-term care hospital or home health agency. Under these retrospective payment models, Medicare continues to make fee-for-service (FFS) payments, the total expenditure for the episode is later reconciled against a BUNDLED PAYMENT determined by CMS. A payment recoupment amount is then made by Medicare reflecting the aggregate expenditures compared to the target price.

MODEL 4: CMS makes a single prospectively determined BUNDLE PAYMENT to the hospital that encompasses all services furnished by the hospital, physicians, and other practitioners during the episode of care.

Our product provides digital logs and document provider services and the costs in real-time in order not to exceed the target price and eliminate the fraud while complying with HIPAA rules.