LOS ANGELES--(BUSINESS WIRE)--Clear Vision Information Systems announced today an enhancement to its revered RevMaxPro software that will allow health plans and providers to more accurately forecast its risk scores in the wake of a new reimbursement approach the Centers for Medicare & Medicaid Services (CMS) will be implementing for payment year 2016.
The new functionality of RevMaxPro takes into account the new CMS 90/10 “blended” model, whereby 10 percent of the CMS payment to health plans will, for the first time, be based on the Encounter Data Processing System (EDPS). The balance of payment will continue to be based on the Risk Adjustment Processing System (RAPS). There are significant differences between the two data sources; and the volume and complexity of EDPS brings with it the potential for errors, exceptions and rejects if not properly calculated.
“In some of the early EDPS/RAPS comparisons, we are seeing anywhere from a 30 to 60 percent mismatch between the data sources,” says Pam Klugman, co-founder and chief products officer of Clear Vision. “This is based in great part on the fact that EDPS contains far more data and is far more complicated than the current RAPS format. If not corrected this could result in significant decreases in revenue for plans and providers.”
Klugman says that many plans are just beginning to seriously consider the implications of the new CMS reimbursement approach or are in the early process of programming but warns that “now is the time to make adjustments and corrections. CMS is likely to increase the weight of the claims (EDPS) data in the risk and financial calculations in the next few years,” she says. “Our RevMaxPro application has everything that is needed and is programmed and ready to go.”
Through its ability to compare claims data to data in CMS files, the RevMaxPro enhancement also allows for the easy identification of mismatches between conditions diagnosed by providers and diagnoses accepted by CMS. In addition, it gives providers the ability to better track what diagnostic and HCC information has been received by the plan and accepted by CMS as claims data is generally refreshed more frequently than CMS files.
“The new functionality provided through RevMaxPro allows plans and providers to work together to eliminate data drop offs and improve business process,” says Klugman. “Doing this efficiently, effectively and collaboratively can have a positive impact on their revenue streams while assuring that patients get the care they need.”
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.
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.