Dynamic’s HCC Analytics Solution Helps Medicare Advantage Plans Identify Inaccurate Risk Adjusting CPT Codes
Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, today announced a new enhancement to its Hierarchical Condition Category (HCC) Analytics solution. The enhancement focuses on identifying and remediating the risk of adjusting Current Procedural Terminology (CPT) codes that may lead to inaccurate CMS payments for Medicare Advantage health plans. Dynamic’s solution identifies CPT codes that are traditionally filtered out. CMS could factor those codes into the plans’ payments which could result in substantial CMS overpayments and possibly steep penalties. Prior to the transition from Risk Adjustment Processing System (RAPS) encounter submissions to Encounter Data System (EDS) encounter submissions that is currently taking place, health plans did their own RAPS filtering which allowed more control for the plans carrying the risk. Under EDS, CMS now applies the filtering logic including CPT codes, which increases the risk of an overpayment to the plan. Dynamic’s advanced algorithms help Medicare Advantage health plans optimize their risk-based revenue by helping the plans identify and remediate encounters that are at risk of triggering CMS overpayments. ... |