Healthcare Economics - NTAP/ClarityPro/Calculator

Question 1

Healthcare Economics - Define CC/MCC

Answer 1

Complication or Comorbidity/Major Complication or Comorbidity.

Presence of additional diagnosis or procedure that may result in reassignment of patient discharge to MS-DRG with higher resource utilization

Question 2

Healthcare economics - Define MS-DRG

Answer 2

Bundled payment that accounts for reimbursement of products and service provided to Medicare beneficiary.

DRG = Diagnosis Related Group

Question 3

Healthcare economics - Define Chargemaster

Answer 3

Comprehensive list of hospital products, procedures, and services. Includes CPT Codes, charge per unit, revenue code, status flags

Question 4

Healthcare economics - 3 main ways Ceribell positively impacts hospital finances?

Answer 4

CAPTURE VALUE
REDUCE COST
ALLOCATE VALUABLE RESOURCES

Question 5

Healthcare economics - What are the two main categories of reimbursement we focus on? Where are these applied? (I.E. what department, in patient? Outpatient?)

Answer 5

CPT Codes (ED/Outpatient) - Professional and Technical Components (Neurologist read fee + technical fee for placing the headband)

DRG (In-Patient) - CPT Professional ONLY (Read-fee only), DRG Codes, and potential CC/MCC CPT Professsional

Question 6

Healthcare economics - Define CPT Professional Component for Reimbursement - where does it apply?

Answer 6

Fee that is going to the “professional”…. going to the Neurologist

“Neurologist Read-Fee” Code

Also potential CC/MCC CPT Professional Code

Does not matter if ED/ICU/Outpatient/Inpatient. No matter what - the NL will be paid for reading the EEG

Question 7

Healthcare economics - Define CPT Technical Component Reimbursement - where does it apply?

Answer 7

Technical fee for placing the headband - ONLY applies to ED/Outpatient Setting

Question 8

What are our three Indications for Emergent EEG?

Answer 8

1 - Seizure Assessment
2 - Post Cardiac Arrest
3 - AMS (Altered Mental Status)

Question 9

What are the 4 Criteria for NTAP Reimbursement?

Answer 9

Clarity Pro
Inpatient
Traditional Medicare/Medicare Adv.
Negative Charge Case

Question 10

What is a negative charge case to the hospital? Why is it important to NTAP?

Answer 10

If hospital costs for the patient are greater than the DRG. It is important because it is one of the criteria for a hospital to claim NTAP

Question 11

What does NTAP stand for? When is ClarityPro NTAP effective date from?

Answer 11

New Technology Add On Payment - Government assigned designation for additional reimbursement from new disruptive medical technologies.

Only 30 companies can get “NTAP” label per year.

Clarity Pro’s NTAP effective date October 1 2023. Only a 3 year designation

Question 12

What is the difference in Alerts between Clarity and ClarityPro?

Answer 12

Clarity can only say “EEG Alert” whereas ClarityPro has FDA Approval to alert for “Electrographic Status Epilepticus”

Question 12

RVU Definition

Answer 12

Relative Value Unit

Question 13

Why DOESN’T the hospital get the Technical Fee for in-patient?

Answer 13

It rolls into the DRG reimbursement

Question 14

How much is NTAP Reimbursement?

Answer 14

Up to $913.90

Question 15

How does Ceribell “Capture Value” to positively impact hospital finances? 4 ways

Answer 15

Use existing CPT reimbursement codes - $85-$115/EEG based on routine and long term EEG CPT codes

Eliminate Diagnostic EEG Transfers - Retain the full DRG payment, $7k on average

Appropriately bill for diagnosed seizures. 10-20% off cases receivee additional CC/MCC ($~2800-~$7700)

Potential NTAP reimbursement - up to $913.90 per eligible patient w/ ClarityPRO

Question 16

How does Ceribell “Reduce Cost” to positively impact hospital finances? 4 ways

Answer 16

Decrease Medication and Intubation Rate (Typically around $900/patient)

Reduce length of stay (1-3 days shorter ICU LOS, $2,800-$13,000/patient)

Eliminate unnecessary transfer costs

Reduced after-hours and on-call time

Question 17

How does Ceribell help hospitals “Allocate Valuable Resources” for positively impact finances?

Answer 17

Allow EEG resources to focus on outpatient care. 60% of STAT EEGs are seizure negative (Allow us to rule out instead of wasting EEG resources)

Reduce after-hours and on-call time

Raise staff satisfaction and retention for EEG Techs