Risk analysis involves identifying risks and vulnerabilities in your practice:

Risk analysis involves identifying risks and vulnerabilities in your practice:

Timely solutions to funding, claims, pharmacy & distributions.

We are proud to introduce MCAR REPORTS a complete set of management reports for IPAs, MSOs and PCP Practices that have Risk Agreements with HMOs Plans. The MCAR Reports give you complete awareness over what is happening with every HMO Plan that your organization participates in risk operations. 

MCAR - MANAGED CARE REPORTS is an online service available created from data files downloaded from HMOs servers. Within 24 to 48 hours our team produces all reports needed to manage your risk business. MCAR Reports are viewed from our secured HIPPA compliant servers however most reports are downloadable in EXCEL format files.

MCAR Reports services can range from only generating reports to having our management team assisting clients in managing the risk operations.

Clients can select MCAR Report services “A LA CARTE” choosing monthly reports needed and/or consulting services they prefer.

Here are some of the options available:  

·         Control over HEDIS requirements, alerting what measures apply to each member of the HMO panel and most importing identifying what measures are pending per member in the reporting period.

·         Summary analysis of funding and expenses including expected distributions, in minutes you know what is going on with your risk operation.

·         A PCP Analysis that shows performance for each PCP in the network from funding, expenditures to net amount after medical expenses. A simple and easy report that enables you to identify and compare all PCP’s performance.

·         MCAR produces a detailed analysis of charges payments and adjustments from Institutional, Professional and Pharmacy claims.

·         A key report - Summary Report showing what each member is costing the panel, a brief breakdown of medical expenses also showing when was the last time the patient came to the office, if ever.

·         A detailed analysis showing all activities for every member - HEDIS measure status, diagnosis codes with MRA evaluation plus each line item of expenses – YOU CAN VIEW THE PRECISE COST OF EACH MEMBER OF THE PANEL.

·         STOP LOSS verification.

·         MCAR Reports claims module – “The ADJUDICATOR” scrubs your professional, institutional and pharmacy claims and also prepares a contestation report requesting adjustments from the Plan.

 

The ADJUDICATOR module employs the most sophisticated scrubbing techniques following CMS and AMA guidelines in processing professional and pharmacy claims. 

CMS show increasing support for value-based care

The shift from fee-for-service to fee-for-value necessitates that providers optimize their operations and align costs with clinical outcomes. 

The time to prepare is NOW. For more details feel free to contact us. 

 

FOR MORE INFORMATION PLEASE CONTACT:

HPP Management Group, Corp.

Developers of the AccuChecker Product Line

Phone: (305) 227-2383  or 1-877-938-9311 

Email: sales@accuchecker.com

Website: http://www.accuchecker.com

 

Medicare Risk Adjustment (MRA)

Medicare Risk Adjustment (MRA)

Risk adjustment is a process that CMS uses to level the playing field regarding the reporting of patient outcomes and Medicare reimbursement based upon patient health status. It enables health plans to be paid appropriately based upon members' overall health.

How does risk adjustment work?

Patient health risks are adjusted using a number of variables, including age, gender, previous health history, and the presence of chronic conditions. This formula yields a member risk score, which is used in calculating payment to a health plan.

2016, the Centers for Medicare & Medicaid Services (CMS) will start to transition from utilizing Risk Adjustment Processing System (RAPS) files, to support the Medicare risk adjustment payment, to encounter files. The transition process is gradual, with a weighted percentage being taken for 2016: 10 percent based on the encounter files and 90 percent based on the RAPS files. With this transition, it is critical that health plans ensure that their RAPS files and Encounter files are in sync. Oh- and the vendors are on the hook for this too.

For some, the financial and operational impact of the transition from RAPS files to EDS files for risk adjustment is still a mystery. On October 23, CMS announced further guidance regarding RAPS and EDS Submissions.

There were three key elements:

1). The addition of diagnoses submitted after the risk adjustment deadline for payment year

2). The submission of HIPPS Codes for CAH’s

3). The use of default NPIs for atypical providers.

Your organization not only needs controls on the front end, it needs quality oversight and standard operating procedures in place to manage the file return elements from CMS.

Providers should be able to report/understand  the analysis of their practice:

§  Operational Assessment Report – Outline of the processes that the health plan currently has in place for RAPS/EDS file submissions, returns and error resolution, providing areas of opportunity for improvement.

§  Variation Analysis Review – Review of findings, outlining instances for potential inaccuracies and risks associated with the health plans current methodology and processes applied to the internal variation analysis.

§  Discrepancy Reports – Identifies opportunities to improve completeness and accuracy of each submission to CMS.

§  Encounter File Member Analysis – Provides detail around the member attributes utilized for risk score calculation to identify gaps when comparing to the RAPS file member analysis.

§  RAPS File Member Analysis – Provides detail around the member attributes utilized for risk score calculation to identify gaps when comparing to the encounter file member analysis.

How to perform/complete the MRA’s ?

HPP AccuChecker is proud to introduce MCAR REPORTS a complete set of management reports for IPAs, MSOs and PCP Practices that have Risk Agreements with HMOs Plans. The MCAR Reports give you complete awareness over what is happening with every HMO Plan that your organization participates in risk operations.

MCAR - MANAGED CARE REPORTS is an online service available created from data files downloaded from HMOs servers. Within 24 to 48 hours our team produces all reports needed to manage your risk business. MCAR Reports are viewed from our secured HIPPA compliant servers however most reports are downloadable in EXCEL format files.

MCAR Reports services can range from only generating reports to having our management team assisting clients in managing the risk operations.

Clients can select MCAR Report services “A LA CARTE” choosing monthly reports needed and/or consulting services they prefer.

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383 or 1-877-938-9311

Email: pesilverio@hppcorp.com

Website: http://www.accuchecker.com

RISK MANAGEMENT SUPPORT

 

 

RISK MANAGEMENT SUPPORT

Medicare and Medicaid Panels

·         Funding and Expenses Reports including MLR computations

o    Reports explaining what is financially happening with each insurance panel 

·         Analysis of Membership, PCP CAP Payments and Funding

o    Verification and contestation of amounts reported by Insurance Carrier

 

·         HEDIS, PQRS and MRA

o    Surveillance of HEDIS and PQRS reporting

o    Review of MRA ratings

 

·         Claims Analysis

o    Review and Recommendations to: Institutional and Professional charges, Stop-Loss transactions, Capitation of Specialists and Ancillary Services, Pharmacy, Emergency Room and Urgent Care, Behavioral Services, Specialists Referrals

o    Contestation to Insurance Carrier for erroneous and/or non-applicable charges 

·         Alerting with information to improving patient care:

o    Identification of patients by diagnosis groups that require attention in a timely fashion

o    Extracting data from Hospital, ER and Urgent care centers charges that can reduce the incidence of visits to these facilities 

·         Assisting with Compliance Issues related to Insurance Carriers, CMS or AHCA needs 

·         Continuous online education and training to office staff, telephone support and periodic  visits and presentations of information 

·         RECOVERY amounts detected from overcharges by the Insurance carrier shall be paid additionally at a rate of 15% of the total amount recovered. 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383

Email: pesilverio@hppcorp.com

 Website: http://www.accuchecker.com

Risk Can Be Managed

Risk management can minimize the chances and effects of bad outcomes and can accelerate the health organization’s recovery from disasters. But it doesn’t mean avoiding all risks. HPP will look at the ins and outs of risk management—what it is, how it works, and determines the best approach for success.

Risk management calls for understanding business risks in general, as well as the specific types of risk an organization faces based on its industry, goals, strategies, and activities.

Specific types of Risk:

·         Funding and membership issues

·         Claims overpayments

·         Overutilization

·         Pharmacy

·         Hospital Admissions

·         Emergency Room

·         Chronic Medical Conditions

·         Noncompliant Patients

 

Risk can be managed. Some risks can be harder to quantify, but they can be analyzed, measured, and managed. The medical practice can be successful with risk management, particularly if the management company has a track record. Health Plans Path (HPP), has the track work, the experience, and the tools to manage your success.

 

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383

Email: pesilverio@hppcorp.com

Website: http://www.accuchecker.com

 

Understanding Risk Management

Understanding Risk Management

 

Risk management can minimize the chances and effects of bad outcomes and can accelerate the health organization’s recovery from disasters. But it doesn’t mean avoiding all risks. HPP will look at the ins and outs of risk management—what it is, how it works, and determine the best approach for success.

Risk management calls for understanding business risks in general, as well as the specific types of risk an organization faces based on its industry, goals, strategies, and activities.

Specific types of Risk:

·         Pharmacy

·         Hospital Admission

·         Emergency Room

·         Chronic Medical Conditions

·         Noncompliant Patients

 

Risk can be managed. Some risks can be harder to quantify, but they can be analyzed, measured, and managed. The medical practice can be successful with risk management, particularly if the management company has a track record. Health Plans Path (HPP), has the track work, the experience, and the tools to manage your success.

  

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383

Email: pesilverio@hppcorp.com

Website: http://www.accuchecker.com