Medicare Database Program
Budget: $180 – $240 USD
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.
https://www.cms.gov/medicare/physician-fee-schedule/search?Y=1&T=3&CT=3
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.
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE
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
https://www.cms.gov/Medicare/Medicare
https://www.cms.gov/medicare/physician-fee-schedule/search?Y=1&T=3&CT=3
https://www.cms.gov/medicare/physician-fee-schedule/search?Y=1&T=3&CT=3
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.
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE
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
https://www.cms.gov/Medicare/Medicare
https://www.cms.gov/medicare/physician-fee-schedule/search?Y=1&T=3&CT=3