OperaCare Launches VBP and Revenue Integrity Toolkit

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Agencies are now able to identify their level of attractiveness as a VBP partner and connect their cost of care with risk of audit review

OperaCare, creators of the software that automates and standardizes the Home Health Quality Assurance (QA) and Compliance process, launched their VBP (Value-Based Purchasing) and Revenue Integrity Tool this week. Proactive management of Revenue Integrity, Cost of Care, and Patient Outcomes will be the difference between those HHAs (Home Health Agencies) who receive bonuses and those who receive penalties. The Toolkit takes publicly reported data, and using OperaCare’s proprietary algorithms, identifies agencies’:

  • Average cost of care per episode;
  • Cost ranking in relation to their regional home health competitors;
  • Amount of revenue they have at risk for audit by the Centers for Medicare and Medicaid Services (CMS) audit contractors.

The free Toolkit can be accessed at http://www.operacare.com/analysis.

“When it comes to the surviving VBP or any bundled payment group, how does an agency know what to improve if they don’t know their current standing?”, said Michael McGowan, Founder and President of OperaCare. "This Toolkit will allow agencies to get an idea of how desirable they are as potential referral partners for ACOs (Accountable Care Organizations), hospitals, APMs (Alternative Payment Models); and the revenue they have at risk for review, possibly leading to complex audit activities. Both these metrics go hand in hand, and it’s this information that most agencies don’t know about themselves. I don’t want good agencies missing profitable opportunities just because they didn’t know what they didn’t know.”

The Revenue Integrity Toolkit makes use of OperaCare’s algorithms, applying historical data versus the pre-claim real-time data that OperaCare’s clients enjoy. While extremely useful and telling, this information comprises only part of an agency’s full story. The history of an agency’s business is written in the data, and CMS depends on their surveyors understanding that history.

OperaCare consumes historical and live OASIS (Outcome and Assessment Information Set) data to create a longitudinal illustration of an agency’s risk, outcomes, and probability of re-certification. This in turn generates the Cost of Care Per Episode, comparing it to the amount saved if OperaCare’s processes are applied. An Agency’s Cost of Care is then ranked against other HHAs within a 25-mile radius, allowing an agency to see a ranking of the most desirable agency another health care provider may want to partner with. This same data is what CMS uses when identifying an agency for review, while OperaCare uses predictive models help the agency avoid said review.

OperaCare users can reduce the level of risk while increasing revenue using the same data points. The live software assisted QA process enables OASIS documentation to be completed in the patient’s home, reducing the workload for field nurses and QA staff. This leads to higher job satisfaction, reduced burnout, and ultimately increases clinician retention. This new approach to QA and Compliance provides a competitive edge never before realized, and prepares agencies for the forthcoming changes in the industry, such as the IMPACT Act or Home Health VBP.


OperaCare is the only software that automates and standardizes Home Health QA and Compliance. Reorganizing the Quality Assurance and Compliance activities from a reactive 1-2 day process, to a live QA process, pre-alerts your staff to toxic data patterns, and presents risk mitigation strategies that prevents the transmission of audit triggering data to CMS/MAC Claims review auditors.

The software automates the Service Utilization Review, the standard operating procedure of hospitals and other primary care settings. It also standardizes the documentation of the OASIS Assessment, a form of documentation that is notorious for subjectivity and open for what the CMS deem as fraud, waste and abuse. Led by an experienced State/OASIS Coordinator the company's mission is to protect HHA provider revenues, enhance business growth and increase financial stability. For more information please visit http://www.operacare.com or for a demo please contact sales(at)operacare(dot)com.

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Michael McGowan
OperaCare, LLC
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