SOLUTIONS

THR's innovative software, Hawkeye DSH Calculator, calculates Medicaid eligible days and automates the preparation of the Medicare DSH calculation for hospitals. Hawkeye DSH Calculator works with the state's eligibility database and, unlike most consultants and hospitals, does not rely on third party vendors.

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Hawkeye Medicaid Eligibility Analyzer examines inpatient and outpatient admissions to find patients not currently identified as Medicaid eligible. The software identifies revenue opportunities missed by billing or third party vendors and helps reduce uninsured and self pay account balances. Patient data is matched with the state Medicaid database monthly.

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Hawkeye SSI recalculates/realigns a hospital’s SSI percentage based on the hospital’s cost report period, rather than using the published SSI percentage. THR clients have utilized Hawkeye SSI for thousands of realignments. 

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Hawkeye Transfer DRG Analyzer identifies both underpayments and overpayments that occur as a result of Medicare's post acute transfer policies. The software generates a detailed account list so that hospitals know where they can resubmit claims for proper payment. Result reports are available within two hours of uploading PS&R or inpatient data. Subsequent reports are generated quarterly.

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Medicare Advantage Analyzer identifies Medicare Advantage patients, a critical appeal issue in both the SSI percentage and Medicaid fraction. If the Allina case is upheld, the software will also exclude Medicare Advantage patients from the SSI percentage. It will also include Medicare Advantage patients that are also eligible for Medicaid in the numerator of the Medicaid fraction.

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Hawkeye Medicare Advantage Shadow/IME Bill Analyzer helps hospitals verify existing and identify missed shadow or IME bill claims. Both processes are essential for Medicare SSI percentage compliance.

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