Risk-based Provider Groups are challenged with obtaining timely, accurate, and actionable information from the Medicare Advantage health plans with whom they have entered into risk sharing agreements.
Dynamic’s feature-rich Hierarchical Condition Category (HCC) Analytics Solution helps health systems close those gaps.
Dynamic’s feature-rich Hierarchical Condition Category (HCC) Analytics Solution helps health systems close those gaps by creating a powerful database that provides a 360-degree view of each patient by:
- Receiving pre-adjudicated claims directly from the health system
- Importing data provided by health system including Rx claims, medical charts, Durable Medical Equipment (DME), labs, etc.
- Importing health plan provided data including Risk Adjustment Processing System (RAPS) submissions, Encounter Data System (EDS) encounters, The Centers for Medicare & Medicaid Services (CMS) Monthly Membership Report (MMR), CMS Model Output Report (MOR), etc.
- Examining all of this source data to identify suspect, missing, or incorrectly coded diagnosis codes – the foundation of Risk Adjustment Factor (RAF) Scores
- Returned to the providers within 24 hours of the patient seeing the provider via reporting, custom designed User Interfaces (UI), and by delivering the results directly to patients’ Electronic Medical Record
- Accepting feedback from providers regarding the identified suspect HCCs
Optimize revenue from:
- Identification of gaps, data leaks, and missing HCCs that may be decreasing revenue
- Identification of care gaps helps improve quality of care
- Advanced algorithms based on population specific diseases ensure capture and submission of all relevant HCC diagnoses
Identify inappropriate diagnosis coding which can lead to overpayments:
- Sophisticated overpayment analysis
- Minimize risk of CMS penalties for future overpayments through:
- Diagnosis code delete analysis, reverse suspecting, and forecasting financial impact
- Risk adjustment filtering and under-filtering analytics
Improve operational efficiencies and reduce costs:
- Patient tracking and reporting identifies patients with low utilization
The HCC Analytics solution helps health systems:
- Utilize diagnosis data from both qualified and unqualified sources – including claims data, pharmacy encounters, and chart audits
- Examine all source data to identify suspect, missing, or incorrectly coded diagnosis codes
- Develop member level and provider level suspect list of missing diagnosis codes and coding errors
- Generate a forecasted patient risk score for both the CMS RAPS and EDS systems to forecast payments
- Refine algorithms to improve suspecting results
- Utilize substantial report library with both canned and ad hoc reporting capability
- Report at the member and provider levels