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In this day and age of minimum medical loss ratios, it might be difficult to preserve a competitive advantage while also optimizing one's bottom-line revenues. Payers are under an increased amount of pressure to generate proper HCC coding as a result of increased oversight from the HHS and the Department of Justice. However, this may prove difficult for organizations that only have a limited number of staff members available to dedicate to these initiatives. RM Healthcare is able to assist you. Our professional staff is able to:
You can't manage the Medicare Advantage and ACA patients you're responsible for without risk adjustment. We at RM Healthcare are here to assist you. Our HCC coding takes risk factors into account, which leads to more precise records of patient characteristics, illnesses, and overall health. The outcome is more accurate per-person cost estimates and fairer pay for everybody.
RM Healthcare's HEDIS-trained nurses and clinically-trained coders will handle all of your chart abstraction needs across all phases of the process. If you need high-quality source data for HEDIS and Medicare Star reporting, our international team has everything you need: the knowledge, technology, and procedures to get the job done.
In order to analyze encounters and conduct thorough clinical chart reviews, our team of registered nurses will access data from your EMR according to NCQA requirements. Verifying that correct care has been provided, documented, and coded entails reviewing patient diagnoses, treatments, and paperwork.
For organizations experiencing personnel shortages, responding quickly to member inquiries can be particularly difficult. RM Healthcare's Provider & Member Contact Services can help manage provider and member communication on your behalf, whether it's in response to clinical issues or enquiries about benefits. We work with you to identify the clinical and operational levers with the most potential to affect cost and quality, and then we develop a communication strategy that is tailored to meet your specific needs.
In addition to our other services, RM Healthcare can assist you in reaching out to your high-risk members in an effort to enhance their chronic care management, save expenses, and boost the quality of life for them. In order to promptly identify concerns requiring proactive intervention, our team of registered nurses and physician assistants analyses data captured from beneficiaries' health monitoring devices.
Provider outreach is an integral aspect of our communications services because we recognize its significance. We'll get in touch with your doctors ahead of time to manage administrative activities like physician credentialing and to talk about ways to get more people to use the health benefits provided by the plan. All parties involved (payers, providers, and patients) benefit from this arrangement.
