Abstract: Methods and systems for estimating costs of perinatological or neonatological care are provided. An example system comprises a communication module for receiving historical perinatal data and beneficiary perinatal data. The system also includes a classification module to determine whether the historical perinatal data has met predetermined criteria. Based on the determination, the classification module selectively analyzes the historical perinatal data and the beneficiary perinatal data and attributes a beneficiary to at least one perinatal care episode based on the analysis. A scoring module of the system ascertains variables for calculation of a risk score associated with the perinatal care episode, determines coefficients corresponding to the variables, calculates the risk score for the beneficiary based on the coefficients, and assigns the beneficiary a financial risk tier based on the risk score for the perinatal care episode.

Abstract: A platform and methods for providing comprehensive palliative and hospice services and a cost calculator are described herein. The platform for providing comprehensive palliative and hospice services includes an analytics tool, a business development tool, a coordinating tool, and a performance improvement tool. The analytics tool is configured to evaluate a patient based on eligibility criteria to determine eligibility of the patient for palliative care or hospice care and create electronic alerts based on the evaluation. The business development tool is configured to facilitate obtaining an order for consultations regarding palliative care or hospice care from a primary care provider and facilitate flow of information among healthcare providers. The coordinating tool is configured to facilitate population of patient data and link healthcare providers and interested parties.

Abstract: A multi-payer clinical documentation e-learning platform and methods for educating at least one health professional about medical necessity criteria associated with a plurality of health plans are described herein. An example method can commence with dynamically compiling health plan data associated with the plurality of health plans. The method may include analyzing the health plan data to extract the medical necessity criteria for at least one medical procedure. The method may further include selectively integrating a health record workflow with one or more e-learning sessions to educate the at least one health professional about the medical necessity criteria in the context of the at least one medical procedure.