I need to make a database program to calculate medicare payments by state, by procedure, by location , by ICD 10 code etc. What I need from someone to make the calculator, which we will run from some databases. The databases are public and for the most part I think I located them.
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We must calculate and verify pricing based on:
• Electronic Standard Claim Transactions: 837I (Institutional claims) 837P (Professional claims)
• Rendering Provider National Provider Identifier (NPI)
• Services Rendered Locality
• Line-level charge information (Units, Dates of service, Procedure codes, Modifier, Place of Service, Revenue codes)
• Diagnosis Related Group (DRG)
• International Classification of Diseases (ICD) – 9/10 codes
• Patient’s Date of Birth
• Patient’s Sex
• Facility Bill Type
• ICD-10-PCS codes
• Condition codes
• Value codes
• Occurrence codes
Then We need to have to run a correction program to see spot an medically unlikely edits.
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A clear understanding of the scope of work required for the task order, with a work plan that will ensure achievement of the objectives set forth in Task 2 and Task 3;
• An overall effective strategy that accomplishes all project goals as outlined in the Performance Work Statement (PWS);
• A clear understanding of the scope of CMS payment methodologies as well as the complexity of CMS legislation, regulations, and guidelines governing payment of Medicare claims;
• Expertise in the use of:
a) Centers for Medicare and Medicaid Services (CMS) payment methodologies;
b) ICD-9 Diagnostic Codes;
c) Common Procedural Terminology (CPT) and HCPCS Level II; and
d) Usage of modifiers, coding guidelines and procedures.
• Medicare Pricing System by incorporating new Medicare regulations and policy changes, to include timelines and retroactive changes
Once we have that setup, I can propose the system for funding. After funding, I would like to put this on a good online platform and introduce the platform features. So I need a good design i can migrate over.
For this part, I need to have a calculator with clear methodology and accuracy. I have to explain every
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Hi, bro!
I have read your requirement and I noticed that I am appropriate to this project.
As a skillful software developer, I have rich experience with database programming and management.
I promise I will finish this project with high quality on time.
I hope you to contact me so that we have a full discuss with the project.
Best regard!
I have extensive experience in all of these areas, with over 30 years experience in Healthcare.
I am familiar with all types of coding. Are you looking for RVUS to calculate pricing?
Are you looking for an EXCEL calculator only or for the CMS data to be imported into the sheet?
Do you prefer a google sheet or Excel? I am not sure the payment you recommend is enough for the import.