All Medicare Advantage (MA) Plans are ultimately 100% financially dependent upon the specific documentation of each individual patient's diagnoses as classified within the highly specific CMS Hierarchical Condition Category (HCC) system. Failure to do so has significant financial ramifications with estimates suggesting that even small Medicare Advantage plans are sustaining more than $10 million in lost reimbursement revenue per year due to a myriad of data, documentation, coding, and reporting errors.
To aid its Medicare Advantage clients, MedAssurant delivers a truly "end-to-end" Capitation Risk Adjustment (CARA™) solution designed to identify, analyze, pursue, and document valid diagnoses not otherwise properly or fully captured by a plan's primary claims systems.
The CARA™ solution demonstrates impressive return on investment. Whether to maximize prospective risk factors for future reimbursement rates or to ensure that full reimbursement is recaptured for past periods in final reconciliation processes, CARA™ assists each MA client to efficiently and accurately implement a system to optimally identify and capture the health characteristics of its enrollees to enable full reimbursement from CMS.
CARA™ Solution Details:
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