LOS ANGELES--(BUSINESS WIRE)--A Medicare Advantage health plan has recouped more than $7 million of reimbursement from the Centers of Medicare & Medicaid Services (CMS) that otherwise would have been lost, thanks to the data and information provided by Clear Vision Information Systems’ RevMaxPro.
RevMaxPro is one of healthcare’s most powerful and easy-to-use data-intelligence tools that helps physicians and health plans identify patients with chronic conditions, pinpoint gaps in treatment, and monitor the reporting of clinical data to CMS. Since its launch it has become an invaluable tool for providers and health plans serving the growing senior market and is integral to effective care management, financial performance and CMS compliance.
“This was a classic case of a health plan needing to provide the right tools and consultation to its physician network in order to increase engagement and ensure correct levels of reimbursement,” says Pam Klugman, Clear Vision’s co-founder and chief product officer. “More and more it is abundantly clear that collaboration and transparency between a health plan and its affiliated medical groups is critical if the plan is going to maximize its revenue while assuring that members get the care they need.”
While acknowledging this reality, the Midwest health plan with more than 50,000 members also recognized the challenges, cost and time required to build out an internal system that could fulfill this immediate need. RevMaxPro was the answer as it provided physicians with near real-time “actionable intelligence” that they could use prior to data submission to CMS. Most importantly, and for the first time, RevMaxPro allowed the providers and the health plan to “read from the same page” both having firsthand access to CMS Reality, which is the basis for all payments.
In addition to providing the technology, Clear Vision also provided a subject-matter expert in the CMS risk adjustment space who worked with the provider groups on the importance of proper documentation and coding as well as illustrating the financial impact of best practices in this environment. During training it became apparent that CMS did not have complete diagnosis data (there were services provided by the physician groups for which CMS had no knowledge) and further examination unearthed that the health plan’s automated processes were not working properly. Correcting this process enabled the collection of the additional $7 million.
This health plan’s experience comes on the heels of a recently released study that revealed a 55 percent improvement in average Hierarchical Condition Category (HCC) scores for those organizations using RevMaxPro. The study also found that organizations who bundle Clear Vision’s RevMaxPro and DxMax products together have a 22 percent higher risk score than non-Clear Vision clients.
“Physicians, health plans and the patients themselves all have a vested interest in collecting, analyzing and using data properly to make sure that the system works as efficiently and effectively as possible,” said Klugman. “The sad truth is that many Medicare Advantage plans and their aligned physicians continue to miss significant opportunities to serve their members and maximize their revenue because of poor performance in this area. Only by working together to generate actionable data will the healthcare system attain the triple aims of high quality, lower costs and an overall better patient experience.”
RevMaxPro is part of a suite of value-added services Clear Vision offers medical groups and health plans. Other portfolio products include: DxMax, a full-service inpatient data collection service; MDMax, a data-pursuit service that enables health plans to identify gaps in reported patient conditions by uncovering missing data at physician sites of service; and SubmissionMax, a single-click diagnosis software launched earlier this year designed to identify, manage and correct RAPS data that health plans submit to CMS.
Clear Vision Information Systems provides Medicare Advantage risk adjustment solutions and strategies to health plans and providers nationwide. Leveraging decades of experience at the forefront of Medicare policy, Clear Vision’s portfolio of products and services – including risk adjustment analytics and easy-to-implement continuity-of-care strategies – help clients maximize their revenue while improving quality of care. For further information, visit www.cvinfosys.com.
