Training and Documentation Support for APR DRG Reimbursement Model Implementation

Client Description

The client, a leading health insurer for a Medicaid Managed Care health plan in the Northeast serving over 300,000 members.

Challenge

The organization decided to migrate all existing acute inpatient hospital contracts to All Patient Refined Diagnostic Related Groups reimbursement. The implementation had to address all aspects of introducing a new reimbursement methodology to the plan’s hospitals, including new contract templates, communication and education, medical and payment policies and procedures, revised operating policies and procedures, financial analysis and modeling, system configuration processes and implementing a new technical solution to group and price claims that would be integrated into the existing claims system. A training strategy needed to be in place, all new processes and systems needed to be documented and several departments needed to be trained.

Technology

This project involved creating a training strategy, documenting the step-by-step integration between the APR DRG grouper/pricer solution and the legacy claims system and training various departments in the new processes. The solution included designing and developing training materials, creating and updating policies and procedures and delivering instructor-led training sessions.

Ninestone’s Approach

Ninestone was brought in to develop the PMO organizational training strategy which included: designing and developing training documentation, creating policies and procedures around the new processes and delivering instructor-led training.

Results

Ninestone delivered training documentation, policies and procedures and all affected departments were successfully trained.