Click here to close now.




















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 just seen a huge influx of new partners coming into our ecosystem, and partners building unique offerings on top of our API set," explained Seth Bostock, Chief Executive Officer at IndependenceIT, in this SYS-CON.tv interview at 16th Cloud Expo, held June 9-11, 2015, at the Javits Center in New York City.
Learn how to solve the problem of keeping files in sync between multiple Docker containers. In his session at 16th Cloud Expo, Aaron Brongersma, Senior Infrastructure Engineer at Modulus, discussed using rsync, GlusterFS, EBS and Bit Torrent Sync. He broke down the tools that are needed to help create a seamless user experience. In the end, can we have an environment where we can easily move Docker containers, servers, and volumes without impacting our applications? He shared his results so yo...
Explosive growth in connected devices. Enormous amounts of data for collection and analysis. Critical use of data for split-second decision making and actionable information. All three are factors in making the Internet of Things a reality. Yet, any one factor would have an IT organization pondering its infrastructure strategy. How should your organization enhance its IT framework to enable an Internet of Things implementation? In his session at @ThingsExpo, James Kirkland, Red Hat's Chief Arch...
Chuck Piluso presented a study of cloud adoption trends and the power and flexibility of IBM Power and Pureflex cloud solutions. Prior to Secure Infrastructure and Services, Mr. Piluso founded North American Telecommunication Corporation, a facilities-based Competitive Local Exchange Carrier licensed by the Public Service Commission in 10 states, serving as the company's chairman and president from 1997 to 2000. Between 1990 and 1997, Mr. Piluso served as chairman & founder of International Te...
It is one thing to build single industrial IoT applications, but what will it take to build the Smart Cities and truly society-changing applications of the future? The technology won’t be the problem, it will be the number of parties that need to work together and be aligned in their motivation to succeed. In his session at @ThingsExpo, Jason Mondanaro, Director, Product Management at Metanga, discussed how you can plan to cooperate, partner, and form lasting all-star teams to change the world...
Public Cloud IaaS started its life in the developer and startup communities and has grown rapidly to a $20B+ industry, but it still pales in comparison to how much is spent worldwide on IT: $3.6 trillion. In fact, there are 8.6 million data centers worldwide, the reality is many small and medium sized business have server closets and colocation footprints filled with servers and storage gear. While on-premise environment virtualization may have peaked at 75%, the Public Cloud has lagged in adop...
The Internet of Everything (IoE) brings together people, process, data and things to make networked connections more relevant and valuable than ever before – transforming information into knowledge and knowledge into wisdom. IoE creates new capabilities, richer experiences, and unprecedented opportunities to improve business and government operations, decision making and mission support capabilities.
How do you securely enable access to your applications in AWS without exposing any attack surfaces? The answer is usually very complicated because application environments morph over time in response to growing requirements from your employee base, your partners and your customers. In his session at @DevOpsSummit, Haseeb Budhani, CEO and Co-founder of Soha, shared five common approaches that DevOps teams follow to secure access to applications deployed in AWS, Azure, etc., and the friction an...
SYS-CON Events announced today that MobiDev, a software development company, will exhibit at the 17th International Cloud Expo®, which will take place November 3–5, 2015, at the Santa Clara Convention Center in Santa Clara, CA. MobiDev is a software development company with representative offices in Atlanta (US), Sheffield (UK) and Würzburg (Germany); and development centers in Ukraine. Since 2009 it has grown from a small group of passionate engineers and business managers to a full-scale mobi...
Digital Transformation is the ultimate goal of cloud computing and related initiatives. The phrase is certainly not a precise one, and as subject to hand-waving and distortion as any high-falutin' terminology in the world of information technology. Yet it is an excellent choice of words to describe what enterprise IT—and by extension, organizations in general—should be working to achieve. Digital Transformation means: handling all the data types being found and created in the organizat...
The Software Defined Data Center (SDDC), which enables organizations to seamlessly run in a hybrid cloud model (public + private cloud), is here to stay. IDC estimates that the software-defined networking market will be valued at $3.7 billion by 2016. Security is a key component and benefit of the SDDC, and offers an opportunity to build security 'from the ground up' and weave it into the environment from day one. In his session at 16th Cloud Expo, Reuven Harrison, CTO and Co-Founder of Tufin,...
The Internet of Things is not only adding billions of sensors and billions of terabytes to the Internet. It is also forcing a fundamental change in the way we envision Information Technology. For the first time, more data is being created by devices at the edge of the Internet rather than from centralized systems. What does this mean for today's IT professional? In this Power Panel at @ThingsExpo, moderated by Conference Chair Roger Strukhoff, panelists addressed this very serious issue of pro...
Discussions about cloud computing are evolving into discussions about enterprise IT in general. As enterprises increasingly migrate toward their own unique clouds, new issues such as the use of containers and microservices emerge to keep things interesting. In this Power Panel at 16th Cloud Expo, moderated by Conference Chair Roger Strukhoff, panelists addressed the state of cloud computing today, and what enterprise IT professionals need to know about how the latest topics and trends affect t...
The essence of cloud computing is that all consumable IT resources are delivered as services. In his session at 15th Cloud Expo, Yung Chou, Technology Evangelist at Microsoft, demonstrated the concepts and implementations of two important cloud computing deliveries: Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). He discussed from business and technical viewpoints what exactly they are, why we care, how they are different and in what ways, and the strategies for IT to tran...
Containers are changing the security landscape for software development and deployment. As with any security solutions, security approaches that work for developers, operations personnel and security professionals is a requirement. In his session at DevOps Summit, Kevin Gilpin, CTO and Co-Founder of Conjur, will discuss various security considerations for container-based infrastructure and related DevOps workflows.