As CMS ties more Risk Revenue to EDPS risk scores, Health Plans turn to Dynamic Healthcare Systems for Reconciliation
Irvine, CA – November 30, 2016 — Medicare Advantage Organizations (MAO) are struggling with the Risk Adjustment Processing System (RAPS) to Encounter Data Processing System (EDPS) transition. Beginning with 2015 Dates of Service (DOS) encounters, 10% of reimbursement dollars are tied to EDPS submissions and 90% are tied to RAPS submissions. For 2016 DOS, the percentage tied to EDPS submissions more than doubles to 25%. Time is of the essence for MAOs to prepare for the complete RAPS to EDPS migration. Dynamic Healthcare Systems, a provider of enterprise-wide solutions for government-regulated health plans, is fully ready to support the CMS transition from RAPS to EDPS and is helping its clients reconcile what is often very different RAPS and EDPS risks scores of their members. Learn how Dynamic is helping its clients with this transition from Dynamic’s Chief Strategy Officer, Jim Corbett on a RAPS to EDPS Reconciliation webinar Wednesday, December 8, 2016, from 11 am – 12 Pm PST. Click here to register.
Dynamic’s previous webinar which took place in November 2016 proved to be helpful to many. Debbie Zander, Quality Improvement and Coding Analyst at Sutter Health, said, “I thought the presentation was excellent! The information was extremely informative and well-presented.”
“Dynamic has been hard at work preparing for the RAPS to EDPS transition. Beginning in 2015, we implemented solution enhancements and launched new professional services aimed at helping our clients quickly and accurately identify discrepancies between RAPS and EDPS risk scores,” said Jim Corbett, Chief Strategy Officer of Dynamic Healthcare Systems. “Our clients are finding that while the majority of their members’ RAPS and EDPS risk scores match, the ones that don’t match represent major impacts to the plan’s risk-based revenue” Mr. Corbett added.
Dynamic’s end-to-end Medicare Advantage platform includes solutions for submitting both RAPS data and EDPS encounters from one source claim reducing the risk of data leakage and inconsistent encounter submissions. Previously, MAOs were only required to submit risk adjustment eligible diagnoses in the RAPS format that required a minimum data set consisting of 7 fields. Now, MAOs must also submit EDS encounters with over 1,700 data elements. As a result, there are common challenges such as discrepancies between RAPS and EDPS. Dynamic’s RAPS to EDPS Reconciliation offers a solution to overcome these common 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.