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This year, the nation's Medicaid programs will pay an estimated $320 billion to physicians, hospitals, nursing facilities, and other providers. The old ways of setting rates, such as percentages of charges, cost reimbursement, and static fee schedules, often have not done a good job for payers. Many states are looking for methods that will do more to encourage cost efficiency, access to services, and quality of care.
ACS can help. As the fiscal agent or facilities manager, ACS is uniquely positioned to help Medicaid programs develop their payment methods, which must operate within complex claims processing systems. Unlike many consultants, we already have in-depth knowledge of your MMIS, your Medicaid program, and your providers.
Examples of projects that ACS can perform:
 Assess current payment methods and develop options for improvement
Design and implement methods to pay for outpatient hospital care based on
Ambulatory Payment Classification (APC) groups
Develop fee schedules for services provided by physicians, therapists,
dentists, and ambulance providers
Update and enhance inpatient prospective payment methods based on
Diagnosis Related Groups
Create incentives to provide quality care
Provide comparisons of Medicaid payment rates with those of other payers
or other states
Provide a bird's eye view of changes in payment methods across the U.S.
Assist with administrative rules, state plan amendments, advanced planning
documents, provider consultation, provider manuals, and technical
documentation
ACS can assist its clients with payment method tasks ranging in scope from several hours to several thousand hours. For most payment method projects, we combine fiscal agent staff from the client state (business analysts, programmers, provider relations) with specialists from other ACS offices across the country to meet your specific needs.
For more information on the future of healthcare payment methods, view the article, .
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