Dynamic Healthcare Systems Announces Enhancements to Identify Errors in CMS Filtering Logic

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Dynamic’s HCC Analytics Solution Helps Medicare Advantage Plans Identify Inaccurate Risk Adjusting CPT Codes

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We are helping our clients identify areas where the CMS filtering logic may be putting them at risk for overpayments.

Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, today announced a new enhancement to its Hierarchical Condition Category (HCC) Analytics solution. The enhancement focuses on identifying and remediating the risk of adjusting Current Procedural Terminology (CPT) codes that may lead to inaccurate CMS payments for Medicare Advantage health plans. Dynamic’s solution identifies CPT codes that are traditionally filtered out. CMS could factor those codes into the plans’ payments which could result in substantial CMS overpayments and possibly steep penalties. Prior to the transition from Risk Adjustment Processing System (RAPS) encounter submissions to Encounter Data System (EDS) encounter submissions that is currently taking place, health plans did their own RAPS filtering which allowed more control for the plans carrying the risk. Under EDS, CMS now applies the filtering logic including CPT codes, which increases the risk of an overpayment to the plan. Dynamic’s advanced algorithms help Medicare Advantage health plans optimize their risk-based revenue by helping the plans identify and remediate encounters that are at risk of triggering CMS overpayments.

“We are helping our clients identify areas where the CMS filtering logic may be putting them at risk for overpayments. We are assisting them with correcting those issues,” said Lonnie Hardin, Chief Operating Officer of Dynamic Healthcare Systems. “To many health plans, increased EDS risk scores might look like a good problem when, in fact, they may represent significant overpayments that can result in substantial fines,” Hardin added.

Dynamic’s robust solutions, including HCC Analytics, provide Medicare Advantage health plans with an enterprise-wide platform that enables plans to automate operations and meet the varied and growing Medicare reporting requirements while also identifying opportunities to maximize revenue. Dynamic’s solutions integrate various sources of health plan and provider data to create a single view of a Plan’s membership. This single view facilitates the delivery of high-quality managed care while helping health plans meet compliance and revenue management challenges.

About Dynamic Healthcare Systems

Dynamic Healthcare Systems provides enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs. Dynamic’s solutions help its clients optimize plan revenue and quality through the utilization of Dynamic’s rich analytics that identify areas for potential improvement, help maintain compliance through ongoing enhancements aligned with CMS regulations, and enhance operational efficiency through fully integrated solution utilizing a centralized database and integrated workflows. Headquartered in Irvine, California, the company offers comprehensive software solutions, managed services, and professional services. For more information, visit dynamichealthsys.com or call 949.333.4565.

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Matt Whitnack - Media Relations
@prdynamic
since: 09/2013
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