Advantmed Physician Record Reviews: Medicare Advantage Plans Gain Clinical Insights for Risk-Adjusted Conditions and Quality/Care Management Opportunities, Impact HCC Coding & CMS Reimbursement

SANTA ANA, Calif.--()--Advantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, today introduces Physician Record Review (PRR), a two-stage retrospective chart review process, first by a certified coder and second with a board-certified physician. This empowers Medicare Advantage (MA) plans with clinical insight into risk adjusting conditions to enhance traditional analytical platforms.

“The ability of physicians to review progress notes for primary care, specialists’ hospital charts, radiology and laboratory results not routinely used in standard analytics provides for more demonstrable actionable information,” says Nilay Shah, president of Provider Solutions, Advantmed. “Additionally, PRR identifies care opportunities in accordance with evidence-based medicine. The Advantmed physician staff are board-certified in their area of specialty with extensive risk-adjustment training to uncover the potential for risk-adjusting conditions not identified by current programs.”

Shah says that PRRs represent one of the best opportunities to focus on Hierarchical Condition Categories (HCCs), explaining, “Our team of physician reviewers identifies HCCs within each patient chart, annotates risk adjustable conditions by page number, and integrates these outputs into a broader array of activities.”

CMS uses HCCs to reimburse MA plans based upon the health of their members. It pays for the predicted cost expenditures of patients by adjusting those payments based on demographic information, Medicaid status and the severity of illness or patient health status as recorded in medical record documentation.

“Advantmed PRRs also confirm the previous two years of submitted HCCs for clinical confirmation not currently submitted in the calendar year,” says Shah. “The goal is to provide a complete picture for the risk adjustment factor, increasing the accuracy of the patient’s risk score and, ideally, creating clean claims and faster reimbursements.”

Advantmed received certification from The National Committee for Quality Assurance (NCQA) for 2018 HEDIS measures for the 12th consecutive year. Read more here.

Contacts: info@advantmed.com; 877.896.7350.

About Advantmed, LLC

Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs. Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members. For more information on Advantmed’s solutions visit www.advantmed.com.

Contacts

CPR Communications
Nicole Dufour, 201-641-1911 x 54
ndufour@cpronline.com
or
Advantmed, LLC
877-896-7350
info@advantmed.com

Release Summary

Advantmed Physician Record Reviews: MA Plans Gain Clinical Insights Quality/Care Management Opportunities, Impact HCC & CMS

Contacts

CPR Communications
Nicole Dufour, 201-641-1911 x 54
ndufour@cpronline.com
or
Advantmed, LLC
877-896-7350
info@advantmed.com