The Problem

Risk adjustment and quality programs drive health plan revenue.

Providers are focused on providing good medical care and consider coding and quality programs a frustrating distraction.

We remove the obstacles and align health plan and provider goals by simplifying the process into a centralized list for closing both coding and quality gaps

HCC Coding

Hierarchical Conditional Category – Diagnosis codes selected by CMS that are used to create a patient’s risk (RAF) score and correlating reimbursement amount. Improve reimbursement by incorporating the documentation of HCC’s into your workflow, based off accurate risk scores.

    • Training to identify & appropriately select HCC codes – sourced from current provider, specialists, hospital discharge summaries, lab results and diagnostic results.

    • Point of care HCC coding guidance.

    • Coding review processes between providers and coders prior to claim creation.

    • Custom extractions from additional sources sent to payers.

    • Shows claim and reporting data imported into the EHR.

    • Identification of suspected codes.

    • Alerts user to overdue codes and drop-offs.

    • Reports tracking provider utilization.

    • Post visit coder training – review chart notes to ensure relevant HCCs were documents during the visit, were coded to the highest level, and have a corresponding plan of care.

Analitico

Analitico is a powerful, easy-to-use tool that parses through a patient’s history and looks for dropped HCC conditions. The system continuously compiles and measures information from myriad data sources, turning cumbersome regulatory projects into actionable solutions. Its rules engine quickly and efficiently uncovers measure and coding gaps and suggests codes, allowing for their discovery with a single sign on. Coder and/or provider decide what is relevant and what should be declined. The entire process is simplified by placing information into a single checklist at point-of-care for suspected code and quality gaps, leading to an increase in scores and revenue. The utility can exist within any EHR or externally as a separate template.

  • Dual-encrypted security
  • Allows for cross comparison
  • View patient’s complete health history, including labs, medications, procedures and claims, even across multiple practices.
  • All information can be exported and sent through secure messaging.
  • Turns projects into transactional data
  • Cloud-based Amazon Web Services
  • Identifies codes lost during transmission from EHR to clearinghouse and/or clearinghouse to payer
  • Offers high-impact touchpoint with providers
  • Eliminates redundant services from incomplete patient history
  • Supports additional business lines such as commercial and Medicare Fee For Service (Certified MIPS Registry)
  • Propagates information with machine learning

Greatest Benefit

Coding becomes part of the workflow
No longer a separate, daunting task
No need for massive chart pulls & reviews
No need for additional effort

 

 

Real results

$170-310 Pmpm
Improved revenue by boosting RAF scores 16-31% 

100%
Identification of codes lost in the transmission process between the provider and health plan

2-3 hours per month
Time saved per provider eliminating reconciling gaps between health plan and EHR

Quality Measure Gap Utility
The quality module gives you the ability to see all your programs across an entire care continuum, along with your entire population, and puts it into an easily identifiable format. The Quality gap module tracks information across many programs, including HEDIS, Star Ratings, PQRS, MIPS, HQM, & more. Drill down for more information about specific measures and patients, so you see what’s going on across your entire patient population both in your EHR and with the health plan. Analitico takes it another step by putting that integration within the EHR, giving providers the ability to see information at point-of-care. 

Coding Gap Module
The Coding Module allows for looking into any coding discrepancies and offering suggestions. It assimilates business and clinical operations by presenting coding opportunities at point-of-care. Suggestions are made by coding team or medical director and pushed to the module, allowing providers and health plans to act upon those suggestions immediately during a patient encounter. This integration and automation ensures accuracy of results, allowing for better provider engagement, improved compliance, and enhanced care. 

Coding rules are constantly being added and kept relevant
Analitico’s library – thousands of coding rules already built in

 

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