Solution Minimizes Risk of Impacted Revenue from Dual CMS Submissions
Irvine, CA. – January 26, 2016 —Government-regulated health plans are concerned about the impact to risk scores and revenue due to CMS requiring Medicare Advantage plans to dual submit encounters to CMS using both RAPS and EDPS. Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare, Medicaid and Exchange programs, announced the availability of a new service offering called RAPS to EDPS Reconciliation. While RAPS has been used for some time, and the amount of data CMS requires is nominal, EDPS is much more complicated and the submissions contain extensive data on each encounter. The risk of revenues being impacted by this dual submission requirement is high.
Dynamic’s RAPS to EDPS Reconciliation service is designed help health plans navigate dual CMS submission complexities by identifying issues and helping plans address them. They key components of the service includes; comparative review of RAPS to EDPS processing to ensure risk is properly reflected, forecast risk adjustment impacts, determine filtering logic applied to encounters resulting in different HCC determination between RAPS and EDPS submissions, report encounter differences between RAPS and EDPS, and report member score and HCC differences between RAPS and EDPS.
“Health plans have been effectively handling RAPS submissions for several years,” said Kathy Feeny, President and CEO of Dynamic Healthcare Systems. “But now that plans are required to simultaneously submit EDPS, they are finding it to be much more complicated than RAPS. The risk that plans’ revenue will be negatively impacted continues to grow. We developed this service specifically to help our clients to quickly identify and mitigate potential revenue issues.”
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 innovations to companies serving the government-regulated healthcare population. For more information visit dynamichealthsys.com or call 949.333.4565.