Dynamic Healthcare Systems Announces Enhancements to Identify Overpayments and Underpayments

Dynamic’s HCC Analytics Solution Helps Customers Identify Inaccurate Encounter Submissions

Irvine, CA – December 6, 2016 – Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, today announced a new HCC Analytics enhancement that focuses on identifying and remediating medical encounters that may lead to inaccurate CMS payments for Medicare Advantage health plans. Dynamic’s solution identifies encounters containing diagnoses that CMS could factor into the plans’ payments which could result in substantial CMS overpayment penalties. Dynamic’s new enhancement additionally identifies encounters missing diagnoses that could cause CMS payments to be under the appropriate amount. Dynamic’s advanced algorithms help Medicare Advantage health plans optimize their risk-based revenue by helping the plans identify and remediate encounters that may trigger these CMS underpayments and overpayments. The analysis includes identifying members’ EDS risk scores that are higher than their RAPS risk scores and helping health plans reconcile those scores, minimizing overpayment risk.

“Dynamic has deep expertise in identifying submission data errors during the open submission periods to assist plans with their delete files and thereby help reduce the threat of overpayment penalties,” said Lonnie Hardin, COO of Dynamic Healthcare Systems. “We are also helping plans identify areas where their CMS risk-based revenue may not be optimal, and assisting the plans to correct those issues,” Hardin added.

Dynamic’s robust solutions provide Medicare Advantage health plans with an enterprise-wide platform that enables a strong risk adjustment strategy ensuring maximum and accurate risk-adjusted payments. Dynamic’s integrated software solutions are designed to ensure health plans meet the complex compliance and data processing requirements that the Centers for Medicare and Medicaid Services (CMS) establishes, monitors, and enforces. Dynamic’s solutions integrate various sources of health plan and provider data to create a single view of a Plan’s membership. This single view facilitates the delivery of high-quality managed care while helping health plans meet compliance and revenue management challenges.

About Dynamic Healthcare Systems
Dynamic Healthcare Systems, Inc. delivers comprehensive enterprise software solutions and services for health plans with Medicare Advantage, Medicaid, and Marketplace lines of business striving to succeed amid new and evolving regulatory requirements. Headquartered in Irvine, California, the company brings world-class and innovative solutions to companies serving the government-regulated healthcare population. For more information, visit www.dynamichealthsys.com or call 949.333.4565.