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
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