Geisinger Health Plan Selects HSS' EASYGroup for Managing Provider Reimbursements; Will Increase Efficiency by Automating Prospective Payment Reimbursement Processes.

HAMDEN, Conn. -- HSS, Inc., the nationally recognized leader in solutions for streamlining coding, regulatory and reimbursement processes, today announced that Geisinger Health Plan, Danville, Penn., has selected EASYGroup(TM), HSS' portable prospective payment software library, for managing provider reimbursements and improving provider contracting.

EASYGroup empowers payers to manage risk and control costs using Medicare's Prospective Payment System (PPS) reimbursement methodology. Its groupers, pricers, editors and other PPS tools seamlessly integrate with claims processing systems to manage Federal PPS (DRG and APC), as well as more than 30 state/payer-specific implementations.

Geisinger Health Plan has integrated EASYGroup with its AMISYS 3000 claims adjudication system to increase the efficiency of its inpatient (DRG) reimbursement processes. Prior to EASYGroup, Geisinger Health Plan calculated inpatient provider reimbursements manually, which consumed significant staff resources. EASYGroup has enabled Geisinger Health Plan to completely automate the DRG reimbursement process, saving them significant amounts of time during claims processing. In addition, EASYGroup enables the health plan to accurately reimburse out-of-network claims at network rates using DRGs, rather than paying these claims at higher percent-of-charge or per-diem rates.

"EASYGroup is specifically designed to address the challenges we were facing," said George Kutz, vice president of operations for Geisinger Health Plan. "This made EASYGroup a clear choice for our organization, especially considering HSS' experience in integrating the solution with AMISYS systems."

Geisinger Health Plan will also use EASYGroup in conjunction with HSS' National Medicare Provider Rate File(TM) (NMPRF) to develop new reimbursement strategies. NMPRF is a national database of payment rates for inpatient PPS and Outpatient Prospective Payment Systems (OPPS) for all Medicare participating hospitals.

"In the future we will be able to use the DRG Grouper within EASYGroup to collect detailed information about inpatient claims that will help us conduct provider-by-provider analyses and review case mixes," Kutz said. "Using EASYGroup together with the NMPRF will improve our provider contracting by enabling us to develop and model reimbursement strategies that balance the financial risks among our provider networks."

"An increasing number of payers are using PPS methodologies as cost management tools to strike a balance between profitability and risk sharing," said Bob Leary, CEO of HSS. "Managed-care organizations such as Geisinger Health Plan are embracing our solutions because they provide the necessary tools for efficiently reimbursing providers using PPS. These solutions also increase first-pass adjudication rates, enable claims verification and auditing, as well as enhance medical/utilization management programs."

About Geisinger Health Plan

Geisinger Health Plan, a not-for-profit health maintenance organization (HMO), serves the healthcare needs of members in 40 counties throughout central and northeastern Pennsylvania. Founded in 1985, Geisinger has steadily evolved into one of the nation's largest rural HMOs by providing high-quality, affordable healthcare benefits.

About HSS

HSS, Inc. (www.hssweb.com) develops solutions that streamline the coding, regulatory and reimbursement processes at provider and payer organizations. HSS' experience with providers and payers enables it to provide the tools and methodologies for organizations to evaluate financial and operational performance, target areas of performance improvement and balance risk-assumption with profit opportunities. These solutions combine technology with HSS' nationally recognized healthcare expertise. HSS solutions are used by more than 900 hospitals and 160 managed-care organizations. They are also embedded in health information management applications offered by 27 of the industry's major software vendors.

EASYGroup is a registered trademark of HSS, Inc. All other company and product names mentioned may be trademarks of the respective companies with which they are associated.