Professional Services | HCC Preci$ion
Support Revenue Recovery & Improve Coding
Accurately coding diagnoses is becoming a focal point of revenue-generating
activity for Medicare Advantage (MA) plans. Under-reporting even one chronic
condition can result in lost revenue of up to $30 to $50 per member, per month
(PMPM). In addition to the negative impact on your Plan's financial
performance; failure to capture all pertinent diagnoses greatly reduce
opportunities to manage care and carry consequences in measuring quality and
deploying pay for Performance programs. In January 2007, CMS will
complete the implementation of a health risk based payment system for managed
Medicare. MA plans need to identify individuals with the potential for existing
clinical conditions that affect CMS payment. Early identification of potential
undocumented conditions is vital to the financial success of the plan.
Now, you can identify undocumented or inaccurately coded diagnoses with DxCG's
HCC Preci$ion™ software. HCC Precision supports revenue recovery
through its quality coding improvement software. The analytics in HCC Preci$ion
detect evidence of under-coding based on historic medical claims data, pharmacy
data, and laboratory test results. Evidence of under-coding is identified at
the patient level and then linked to the members Primary Care Physician (PCP)
provider to present a historic view of the providers who have seen the member.
Reports by PCP are designed to guide your program staff in communication with
providers and their office personnel who can review the patient clinical record
and billing history. This is a key step toward ensuring that payments from CMS
accurately reflect the illness burden of the population
HCC Preci$ion Reports can be generated to provide managers with a view of how risk is
distributed across the population and help pinpoint any systematic issues in
data submission or the quality of services provided by your health care
network.