Do More With Less
Knowing what conditions have been, or need to be re-assessed is the foundation that effective HCC management provides. CVInfosys’ HCC tools and methods yield high levels of knowledge, fostering opportunity. When deployed at a plan or provider level, RevenueMax™ supplies proactive intelligence that supports patient outreach, physician assessment, case management, and optimization of documented care, resulting in right-sizing CMS revenue.
Issues in right-sizing CMS reimbursements arise when there is a lack of medical record documentation to support coding of a specific condition, when there is a history of untreated chronic conditions, or where conditions are showing up as under-reported. All chronic conditions must be assessed and documented in the medical record on an annual basis under the Medicare HCC payment model.
While many ICD-9 codes are successfully reported through claims and encounter submission, due to system limitations and the use of EDI vendors, codes sometimes drop off and never make their way to CMS for acceptance. CVInfosys has expertise in understanding where data leaks may occur, and provides data pursuit services (DxMax™, MDMax™) and data analytic/correction tools (RevenueMax™, SubmissionMax™). The result is a more robust and timely HCC data set which leads to less revenue drop-off and more resources to channel back into your bids, plan design, and health care delivery.