Welcome!

News Feed Item

MedAptus Announces Availability of Risk Severity Toolkit to Assist with HCC Coding

Newest Product Offering Leverages Visit and Charge Data to Ensure Maximal Reimbursement

BOSTON, Feb. 11, 2014 /PRNewswire/ -- MedAptus® today announced that it has released a Risk Severity Toolkit to help provider groups measure and manage the disease burden of patients covered under risk-based contracts. The initial version focuses on the Medicare Advantage (MA) patient population where premiums paid to MA health plans are based on enrollees' severity history using the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) model. Providers are increasingly at risk under contracts with MA plans, both financially and administratively, to properly document and manage patients' clinical risk.

In 2004, CMS upgraded its method to adjust capitated payments to MA plans using the HCC model, based on health expenditure risk of enrollees. Prospective risk estimates are based on patient demographics and conditions documented from encounters occurring in previous and current years. The process of HCC coding can pose a challenge to physician groups because CMS requires new problem documentation each year to create a current profile of member risk.  If severity is not documented in an accurate and timely manner, payment is reduced to the health plan, and increasingly to providers as well under their contracts with, or as sponsors of, these plans.

MedAptus has a demonstrated ability to leverage data within its Pro Charge Capture software to drive complementary, clinical data collection, such as with the company's PQRS and P4P functionality. Similarly, the MedAptus Risk Severity Toolkit now eases the process of HCC coding.  The first step is an alert when a MA patient has an office visit and requires a severity evaluation and diagnosis documentation. From here the Toolkit profiles documented patient demographics and clinical conditions relevant to the HCC model, both prior and current year, for provider review during the encounter. The detailed Patient Severity profile also applies the HCC model to quantify the patient's severity scores based on those histories.  Providers can quickly re-assess the patient's past and current clinical status to properly document new or continued manifestations requiring management. The Toolkit also includes analytical reports to compare patient severity scores over time across all at-risk health plans.

"Across our customers, it's evident that risk is shifting to providers based on clinically-based performance measures," said Dennis Bush, who manages MedAptus' Reporting and Analytics products. "In our development of the Risk Severity Toolkit, the immediate challenge we recognized is how to assure that clinicians properly assess and document conditions to correctly measure severity scores. Based on customer feedback, we have a practical solution, fitting naturally into the clinical workflow of providers."

The timing of this product release will help provider organizations on several fronts. Once ICD-10 goes into effect later this year, the number of diagnosis codes mapping to HCCs will increase, making this process even more complex for groups. Secondly, enrollment in private MA plans has been on an upward trajectory, with over 14 million covered lives in 2013, compared to 12 million only two years earlier. And CMS has aggressively audited, challenged, and recovered billions in excess premium payments to MA plans, who are in turn pressing providers for proper documentation.

"Traditionally, risk has been assumed primarily by purchasers and payers, but with the movement to value-based medicine and emerging ACO payment models, providers will absorb more risk, placing greater emphasis on the need for appropriate encounter documentation and both financial and quality management of that patient risk. Our Risk Severity Toolkit is a strong platform to accomplish these objectives given its leverage of demographic, visit and charge information within the MedAptus database," added Bush.

About MedAptus Corporation
MedAptus is the Gold Standard in the healthcare revenue cycle for achieving effective charge management, compliance and workflow efficiency. With offerings that include powerful and easy-to-use charge capture and management technologies, it is no wonder that many of the nation's most prestigious healthcare organizations rely on MedAptus for financial optimization. Our full-scale Professional, Technical, and Infusion applications increase revenue, enhance EMR investments, re-engineer manual processes and yield substantially improved productivity. For more information, visit www.medaptus.com, or call 617.896.4000.

Read more news on MedAptus.

MedAptus Contact: Jennifer Crowley
p. 617.896.4030
Email

 

SOURCE MedAptus

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
"We've been engaging with a lot of customers including Panasonic, we've been involved with Cisco and now we're working with the U.S. government - the Department of Homeland Security," explained Peter Jung, Chief Product Officer at Pulzze Systems, in this SYS-CON.tv interview at @ThingsExpo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"DivvyCloud as a company set out to help customers automate solutions to the most common cloud problems," noted Jeremy Snyder, VP of Business Development at DivvyCloud, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"We're here to tell the world about our cloud-scale infrastructure that we have at Juniper combined with the world-class security that we put into the cloud," explained Lisa Guess, VP of Systems Engineering at Juniper Networks, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
Your homes and cars can be automated and self-serviced. Why can't your storage? From simply asking questions to analyze and troubleshoot your infrastructure, to provisioning storage with snapshots, recovery and replication, your wildest sci-fi dream has come true. In his session at @DevOpsSummit at 20th Cloud Expo, Dan Florea, Director of Product Management at Tintri, provided a ChatOps demo where you can talk to your storage and manage it from anywhere, through Slack and similar services with...
"We were founded in 2003 and the way we were founded was about good backup and good disaster recovery for our clients, and for the last 20 years we've been pretty consistent with that," noted Marc Malafronte, Territory Manager at StorageCraft, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"At the keynote this morning we spoke about the value proposition of Nutanix, of having a DevOps culture and a mindset, and the business outcomes of achieving agility and scale, which everybody here is trying to accomplish," noted Mark Lavi, DevOps Solution Architect at Nutanix, in this SYS-CON.tv interview at @DevOpsSummit at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"We are an IT services solution provider and we sell software to support those solutions. Our focus and key areas are around security, enterprise monitoring, and continuous delivery optimization," noted John Balsavage, President of A&I Solutions, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"We provide IoT solutions. We provide the most compatible solutions for many applications. Our solutions are industry agnostic and also protocol agnostic," explained Richard Han, Head of Sales and Marketing and Engineering at Systena America, in this SYS-CON.tv interview at @ThingsExpo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"We want to show that our solution is far less expensive with a much better total cost of ownership so we announced several key features. One is called geo-distributed erasure coding, another is support for KVM and we introduced a new capability called Multi-Part," explained Tim Desai, Senior Product Marketing Manager at Hitachi Data Systems, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
There is a huge demand for responsive, real-time mobile and web experiences, but current architectural patterns do not easily accommodate applications that respond to events in real time. Common solutions using message queues or HTTP long-polling quickly lead to resiliency, scalability and development velocity challenges. In his session at 21st Cloud Expo, Ryland Degnan, a Senior Software Engineer on the Netflix Edge Platform team, will discuss how by leveraging a reactive stream-based protocol,...
SYS-CON Events announced today that Calligo, an innovative cloud service provider offering mid-sized companies the highest levels of data privacy and security, has been named "Bronze Sponsor" of SYS-CON's 21st International Cloud Expo ®, which will take place on Oct 31 - Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Calligo offers unparalleled application performance guarantees, commercial flexibility and a personalised support service from its globally located cloud plat...
DevOps at Cloud Expo, taking place October 31 - November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 21st Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The widespread success of cloud computing is driving the DevOps revolution in enterprise IT. Now as never before, development teams must communicate and collaborate in a dynamic, 24/7/365 environment. There is no time to w...
Internet of @ThingsExpo, taking place October 31 - November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 21st Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The Internet of Things (IoT) is the most profound change in personal and enterprise IT since the creation of the Worldwide Web more than 20 years ago. All major researchers estimate there will be tens of billions devic...
"The Striim platform is a full end-to-end streaming integration and analytics platform that is middleware that covers a lot of different use cases," explained Steve Wilkes, Founder and CTO at Striim, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"With Digital Experience Monitoring what used to be a simple visit to a web page has exploded into app on phones, data from social media feeds, competitive benchmarking - these are all components that are only available because of some type of digital asset," explained Leo Vasiliou, Director of Web Performance Engineering at Catchpoint Systems, in this SYS-CON.tv interview at DevOps Summit at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.