MAP Medicare
CMS requires all qualified managed care organizations (MCOs) to identify all chronic conditions and severe diagnoses for each member and to substantiate a health risk profile for those individuals. Documentation in the medical record must support the presence of the condition and indicate the provider’s assessment and plan for managing the condition. Incorrect or non-specific diagnoses can affect patient care and outcomes and associated reimbursement for those members.
Manage Risk Adjustment for Medicare Effectively
Invent Health’s Medicare risk adjustment module leverages the MAP which utilizes proprietary AI and ML-based algorithms to drive proactive evaluation of member risk scores. The analysis includes structured and unstructured data sets like claim, pharmacy, lab, and chart review data.
The product provides real-time visibility needed to prevent revenue leakage and to manage risk adjustment revenue against budgeted gap closures and key performance indicators (KPIs).
The Medicare risk adjustment product provides a rich visualization and workflow solution to manage risk adjustment for Medicare. Through MAP’s Medicare risk adjustment product, customers can identify risk coding opportunities, prioritize high-risk members, visualize revenue impacts, and improve their overall risk adjustment program.
Key Features of MAP Medicare
The keys features of the product are designed to assist across the Medicare programs:
MAP has predictive models to chase and drive wellness programs to improve quality while correctly charting conditions.
MAP has a near-real time API service which uses ML and AI models to drive accurate chart chase programs early in the cycle.
MAP’s utilization analytics module drives and targets high risk populations to drive wellness programs.
MAP provides an accurate prediction of financial impacts, revenue projections, and impact of risk optimization programs.
MAP has APIs that integrate with encounter submission processes to prioritize high risk claims for submission.
Data Ingestion and Risk Analytics
MAP-Medicare supports various data inputs and helps in performing the analysis.
- Intaking 837, CSV, XML or a custom input of claims, pharmacy, and clinical data
- Loading Mao004 to reconcile and find discrepancies in data
- Supporting HICN to MBI reconciliation
