MAOs:- HCC, RADV Audits, Star Rating, HEDIS

3Gen manages the entire cycle of HCC (hierarchical condition category) code assignment and documentation training, providing Medicare Advantage (Part C) plans the information they need to adequately quantify risk and plan for the future. Our team of experienced professionals identifies risk areas, calculates financial impact, and engages in thorough cost analysis to justify business intelligence strategies. The process of data retrieval, analysis, and communicating documentation and coding methods to physicians, requires careful planning and experience. Managed care organizations find that they can reduce their operating expenses by turning to 3Gen for the management and execution of the systems necessary to fully capture the ICD-9/10 codes that determine HCC assignment.

There are four main elements that comprise the HCC coding cycle as outlined below. Each demands its own logistical considerations and skill set to perform. We achieve cost savings throughout each part of the cycle by understanding every aspect of the necessary inputs and carefully planning and coordinating their implementation.

The Centers for Medicare and Medicaid Services (CMS) perform risk adjustment data validation audits on patients’ medical records. Risk adjustment data validation (RADV) is the process of verifying diagnosis codes submitted for payment are supported by medical record documentation. The purpose is to ensure risk adjusted payment integrity and accuracy. CMS has announced its intention to increase auditing activity consistent with an emphasis to reduce payment errors.

The Medicare 5-Star Quality Rating System was created as part of the Patient Protection and Affordable Care Act (PPACA) to provide bonus payments based on quality rating metrics for Medicare Advantage (MA) plans. But what is a star in the system worth? About $50 per member per month (PMPM), according to L.E.K. Consulting, when moving from a three to four star MA plan.

CMS rates Medicare Advantage plans by assigning a ‘star-rating’ which adds HEDIS measures, member satisfaction scores and the results of a health outcomes survey to its own data. The stars, which range from one (poor performance) to five (excellent performance), correspond to bonus payments added to the funding that plans receive from CMS.

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"Testimonials"

  • Lab Services has increased revenue and efficiency in our practice while providing reliable services. I feel secure knowing that 3Gen Consulting is watching over our business while we watch over my patients. The comprehensive reviews by their experienced coders have been very helpful to our practice. Working with 3Gen Consulting reassures us that our billing is accurate and complete. We know their coders are capturing all the appropriate charges and minimizing the potential adverse consequences of overbilling.

    - Irene Davis

    Administrator (Lab Services) Chicago, IL

  • "3Gen Consulting is not just our client but rather has been an integral part of the success story of our company and we are delighted with this partnership and intend to continue to grow our business with our preferred partner in the years to come". Our progressive increase in Coding accuracy is a direct result of the accurate and professional services provided by 3Gen Consulting."

    - Susan Smith

    Director of Coding Services, Multispecialty Billing Group NY

  • We are pleased with your team having excellent knowledge, tools, technologies and the most of it the experience starting from eligibility, charges, remittance posting, coding, collection to reconciliation. My satisfaction purely reflects in my finances.. We have been very happy with your work and the immediate responses from your staff in regards to our simplest needs. Long way to go...

    - Linda Smith

    Manager, Large Medical Billing Company in IL

  • The timelines and chronologies are customized according to the guidelines provided. Great job! The analytical and logical summaries from 3 Gen exceed my expectations as a QME. Good job Team.

    - V. Patel

    MD, Chicago, IL

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