As CMS increasingly ties Risk Revenue to EDS risk scores, Health Plans turn to Dynamic Healthcare Systems for Reconciliation
Irvine, CA – September 21, 2017 – Medicare Advantage Organizations (MAOs) are struggling with the Risk Adjustment Processing System (RAPS) to Encounter Data System (EDS) transition. Beginning with 2016 Dates of Service (DOS) encounters, 25% of 2017 reimbursement dollars are tied to EDS submissions, and 75% are tied to RAPS submissions. For 2017 DOS, the percentage tied to EDS submissions decreases down to 15% for 2018 payment. This EDS submission percentage downgrade can be attributed to numerous problems with the CMS risk adjustment logic (i.e., MAO-004). CMS has made three significant corrections to their logic, which has made it very difficult for plans to manage and forecast 2017 payment without reconciliation tools. Time is of the essence for MAOs to prepare for the complete RAPS to EDS migration.
Dynamic Healthcare Systems, a provider of enterprise-wide solutions for government-regulated health plans and health systems, is fully ready to support the CMS transition from RAPS to EDS and is helping its clients reconcile what is often dramatically different RAPS and EDS 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 EDS Reconciliation webinar Thursday, September 28, 2017, from 9:30 am – 10:30 am PST.
Dynamic’s popular RAPS/EDS webinars have proven to be very helpful to attendees. 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 EDS 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 EDS risk scores at the member and HCC level,” said Jim Corbett, Chief Strategy Officer of Dynamic Healthcare Systems. “Our clients are finding that while the majority of their members’ RAPS and EDS risk scores match, the ones that don’t often represent major impact 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 EDS 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 EDS. Dynamic’s RAPS to EDS Reconciliation offers a solution to overcome these common challenges.
About Dynamic Healthcare Systems
Dynamic Healthcare Systems provides comprehensive solutions to health plans and health systems participating in Medicare Advantage, Managed Medicaid, and Marketplace programs. Dynamic’s solutions help its clients optimize plan revenue and quality through the utilization of Dynamic’s rich analytics that identify areas for potential improvement, help maintain compliance through ongoing enhancements aligned with CMS regulations, and enhance operational efficiency through fully integrated solution utilizing a centralized database and integrated workflows. Headquartered in Irvine, California, the company offers comprehensive software solutions, managed services, and professional services. For more information, visit dynamichealthsys.com or call 949.333.4565.