Medicaid Payment Method Development

On average, the nation’s Medicaid programs pay about $600 billion annually to physicians, hospitals, nursing facilities, health plans and other providers. It’s no wonder that many states are looking for improved cost efficiency and greater payment value while increasing access to Medicaid services and quality of care.

The payment method development team at Conduent specializes in understanding standard health care industry payment methods such as DRG, RBRVS, APC, RUG and fee schedules. We have in-depth knowledge of MMIS and Medicaid claims processing systems as well as Medicaid programs and providers.

Our expertise has included a wide variety of projects such as:

  • Design and implementation of DRG payment methods in six states
  • Conduct one of the nation’s most in-depth analyses of variation in payment to all of a state’s hospitals across public and commercial payers
  • Analysis of a state’s potentially preventable complications and readmissions at statewide and hospital-specific levels and provision of hospital-specific quality results to more than 450 hospitals
  • Design and implementation of value-based payment methods for outpatient hospital care, nursing facilities, physicians and other providers and payers

Our dedicated team has a flexible approach that caters to your specific challenges and goals. We provide you with solutions that improve health outcomes, increase administrative and operational efficiencies while saving money for your patients, payers and providers.