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Clear Vision Information Systems Warns Medicare Advantage Plans That "Window is Closing Rapidly" to Capture Data, Impact Revenue
[August 19, 2014]

Clear Vision Information Systems Warns Medicare Advantage Plans That "Window is Closing Rapidly" to Capture Data, Impact Revenue


LOS ANGELES --(Business Wire)--

With the third quarter of 2014 winding down, Medicare Advantage plans are facing a short window of time to impact their final reconciliation payment from the Centers for Medicare and MediCaid (CMS). That's why one of the industry's leaders in data collection and reporting is urging these plans to focus on this now.

"Plans that wait until the March sweeps to do their diligence will sub-optimize their cash flow and delay payment until the second half of 2015 at the earliest," says Tom Peterson, president of Clear Vision Information Systems. "With data to support CMS Final Reconciliation due Jan. 31, now is the time to implement tactics that will assure that plans have an accurate record of services rendered and thus recover all of the dollars to which they are entitled."

Peterson says that in order to have a complete picture of services provided on behalf of an individual member or patient, data needs to be collected from both physician and hospital visits. "Collecting data from a hospital is critical because it often results in diagnoses that may not show up in a physician's office visit. In other instances, a patient may bypass their physician altogether and go straight to a hospital setting. Either way these are services and expenses that need to be captured," says Peterson.

Fortunately today there are programs available that make data pursuit more complete and accurate than ever. One of the industry's foremost services, Clear Vision's DxMax™ for example, puts an end to missed and under-reported inpatient stay diagnosis codes, giving health plans the ability to correct inaccuracies or gaps when it counts most - pre-CMS sweep.



The DxMax multi-step process begins with developing a target list of claims most likely to be under-reported. DxMax then launches a multi-touch campaign that includes both mail and outbound calls to maximize hospital response. Using advanced data-pursuit algorithms to target and obtain missing data, DxMax leverages relationships with more than 6,000 hospitals and care facilities nationwide to collect the additional or corrected data and seamlessly and easily provides it to the health plan. Newly captured data is entered for all diagnosis codes, and a paper trail is created for easy identification. DxMax then delivers reports in a client-specific format for the health plan to process and package before sending codes to CMS.

"This process results in exceptional accuracy and is actually less expensive than a traditional chart review," says Peterson. "Users of DxMax generally see an ROI of anywhere from 5:1 to 15:1. What's more, thorough capture of diagnosis codes provides early warning indicators for better medical and quality management, while helping a plan to right size its CMS revenue," he says.


DxMax is part of a suite of services Clear Vision offers medical groups and health plans. Other portfolio products include: RevMaxPro, one of healthcare's most powerful and easy-to-use data-intelligence tools that provides health plans and providers an integrated view of their Medicare Advantage members; SubmissionMax, a single-click diagnosis code identification and correction software that helps health plans easily manage and correct CMS-rejected diagnoses; and MDMax, a data-pursuit service that enables health plans to identify gaps in reported patient conditions by uncovering missing data at physician sites of service.

Clear Vision Information Systems provides Medicare Advantage risk adjustment solutions and strategies to health plans and providers nationwide. Leveraging decades of experience at the forefront of Medicare policy, Clear Vision's portfolio of products and services - including risk adjustment analytics and easy-to-implement continuity-of-care strategies - help clients maximize their revenue while improving quality of care. For further information, visit www.cvinfosys.com.


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