TAKE CONTROL OF YOUR MEDICARE ADVANTAGE FINANCIALS
Know what you are missing out on
Scheduled payments from Centers for Medicare and Medicaid Services (CMS) are decreasing. It’s an unavoidable fact. You are faced with the challenge of how to wring every efficiency out of your system. Where there was once an acceptable margin of error, today there is none.
Every single membership and payment transaction with CMS needs to be accurate for compliance and to shore up your bottom line. Information for reimbursement needs to be right every month; carrying errors forward even one month negatively affects your financials.
Our flagship Advantage360˚ solutions are utilized by 500+ payer customers nationwide. Our Revenue360° solution is our end-to-end MA and PD revenue and risk management departmental solution. Revenue360° is used to manage revenues for over 3,000,000 MA and PD members.
Reconciliation that is accurate
With Infocrossing’s Membership and Payment Reconciliation (RECON), it is now possible to send CMS the correct information every month. Enrollment, data and payment discrepancies are identified before you send data, assuring that monthly processing is done accurately.
Our systems and business process reconciles CMS monthly membership and payment data to Plan membership data and provides a system-calculated plan expected payment. Enrollment discrepancies, data and payment discrepancies are adjusted automatically. Online capabilities are available for your team to review and work the discrepancies. CMS and Plan payments are tracked at the Plan, PBP and member level so you can see clearly at all levels, and reports and extracts feed directly into your financial system for access at your fingertips.
Analysis to track success
A significant portion of your revenue is generated from claims data submitted and approved per CMS rules (RAPS submissions and sweeps). Infocrossing’s RA-Expert will analyze your risk scores based on RAPS submissions and compare them with historical data to determine potential missing HCCs from the current payment year. The potential HCCs are quantified, and RA-Expert identifies the financial impact of the missing data. In addition, RA-Expert will identify the impact for prospective payment years, as well as the current payment year.
Our system provides summary financial reports, as well as member-level detail reports including the identified missing HCCs and the associated Diagnoses for use in chart review processes so you can make appropriate adjustments before the next reporting period.
Decrease RAPS errors while increasing RAPS data manageability
Infocrossing’s RAPS-Expert automates and streamlines the submission process. It checks for errors such as duplicate cluster submission, unacceptable data sources and diagnosis not in HCC model. Enrollment timing errors are flagged for automatic resubmission, once the member is on record.
Your team minimizes the amount of time spent preparing, processing, reviewing and reconciling RAPS data and focuses on the future.
See the difference
With our automated systems working to streamline your submissions reporting, you really do get a 360° view. Get clean data to CMS by identifying issues prospectively, not retrospectively, and maximize your reimbursement every month.
The Infocrossing Difference
Infocrossing is a premier provider of selective IT and Business Process Outsourcing solutions. Over 80 percent of Medicare Advantage Plans take advantage of our solutions to address their membership management, eligibility/enrollment, payment reconciliation and clinical risk adjustment business and regulatory requirements. With the backing of our parent company, Wipro Ltd., a $5.5 billion technology services company, we offer proven technical delivery capabilities and long-term financial stability unmatched in the industry.
Call Infocrossing Now
For more information, please contact Infocrossing at 866.779.4369.
