Solution and Approach
Solution and Approach
Our approach uses analysis of medical and prescription drug data to identify relevant diagnosis that are potential markers for a diagnosis that CMS would recognize for additional payment. This analysis considers prior diagnosis, prior year HCC's, and expected comorbidities. These "suspect" diagnoses are identified for review and confirmation by a certified coder.
Upon confirmation of the suspected diagnosis, the additional diagnoses are submitted to CMS for inclusion in the HCC calculation, driving payment adjustments in your favor.
Beam utilizes a team steered by a project manager, nurses, and code reviewers to assess data and medical charts. Our staff works closely with the health plan's staff to ensure cooperation with the providers and to maximize the recovery of the lost premium.
Opportunities
Prior to a detailed review of claims data, our team can estimate potential financial opportunity. Our prior experience indicates an estimated recovery of $3 million for every 10,000 members in the Medicare plan. For 25,000 members this is approximately $7.5 million.
Costs
Beam will provide an estimate on all project and software costs associated with the project. Costs and expenses are billed and payable when invoiced.
Begin Now
The deadline is January 31, 2007 for 2005 claims. The earlier the plan begins this review, the higher rate of recovery is possible.
Contact Beam Partners for a review and estimate of your potential recovery costs. The difference could mean literally millions of dollars in your favor.