Under the Medicare Advantage (MA) program, the Centers for Medicare and Medicaid Services (CMS) pays private health insurance plans to provide Medicare benefits to their enrollees. This option is increasingly attractive to Medicare beneficiaries, with over one-third selecting a Medicare Advantage plan in 2019. As a public-private partnership, Medicare Advantage runs differently than the traditional Medicare program, and these differences can place additional burdens on clinicians and groups. Having an EHR partner that understands the complexities of Medicare Advantage is crucial for obtaining the elusive five-stars for your program. Whether your group participates in an exclusive Medicare Advantage network or accepts Medicare Advantage enrollees from multiple plans, TempDev can help optimize your NextGen EHR implementation. Here are three ways TempDev and your NextGen EHR can simplify and improve your Medicare Advantage experience.
Maximize Your Medicare Star RatingIn Medicare Advantage, each plan receives a star rating from CMS. Star ratings measure both the quality of health plan operations and the quality of patient care that enrollees receive. The quality of care you provide will help determine each Medicare Advantage plan's star rating. Generating and maintaining high star ratings is critical to Medicare Advantage plans' operations. Star ratings determine the maximum payment available to CMS plans, and they are also included in the Medicare Plan Finder, where higher star ratings drive higher enrollment. As a clinician or group, the Medicare Advantage plans you work with will expect you to generate high star ratings through clinical quality measures like receipt of preventive services and chronic condition management. If you accept Medicare Advantage patients or are integrated with a Medicare Advantage plan, your group will be required to submit quality data, such as Healthcare Effectiveness Data and Information Set (HEDIS) and other measures. TempDev can optimize your NextGen EHR to minimize the burden of quality reporting and help you improve your Medicare star rating quality scores. Improving quality scores must be managed holistically:
- Outreach - Utilize NextGen Care or clinical NextGen EHR BI reports to improve your patient population health.
- Point of Care - The best opportunity to improve patient care and quality scores is to see the gaps in care while with the patient by utilizing TempDev's Quality Dashboard NextGen EHR template.
- Monitor Quality Scores - Review how physicians are progressing towards meeting their quality measures and provide feedback and retraining as needed.
- Closing the Order Loop - Ordering referrals, labs, and diagnostic procedures are only part of improving a patient's health. Ensure your patients are completing the orders by closing the order loop with TempDev's Order Management NextGen EHR template or Open Orders NextGen EHR report.
Ensure Complete and Accurate Data for Risk AdjustmentIn the Medicare Advantage program, plans with higher-risk enrollees receive additional CMS payments through the Medicare risk adjustment system. To ensure proper payment for the relative risk of their patient population, Medicare Advantage plans must provide CMS with complete and accurate data on diagnoses for all their enrollees. As with star ratings, Medicare Advantage plans rely on participating clinicians and groups to code each patient's diagnoses accurately and completely, which means more reporting burdens for your group. Because HCC diagnoses with higher RAF scores affect plan payments, you can expect the Medicare Advantage plans you work with to request data extracts and follow-up to ensure complete coding of all diagnoses for your patients. Your NextGen EHR can help you appropriately code and track patients' HCC diagnoses, reducing Medicare Advantage plans' requests for additional data. TempDev has developed NextGen EHR templates to maximize the capture of diagnoses relevant for risk adjustment, including identifying suspected, overdue, and drop-off diagnoses. TempDev can also help you comply with CMS risk adjustment audit requirements, reducing your risk of negative audit findings. By improving risk adjustment HCC diagnosis coding and preparing for audits in advance, you can minimize follow-up data requests from Medicare Advantage plans. These tools also have benefits for you beyond Medicare Advantage optimization. For example, maximizing the capture of diagnoses will help you streamline the workflow between clinicians and HCC coders, reducing the time spent coding and billing for traditional Medicare and other payers. Plus, a more complete diagnosis history for each patient can help you improve care and reduce inadvertent medical errors.
Generate Data Extracts for PayersMedicare Advantage plans' revenue depends on high star ratings and accurate, complete HCC diagnosis coding for risk adjustment. Therefore, Medicare Advantage plans have incentives to improve care quality, track patient progress, and close care gaps. These incentives can mean frequent requests for NextGen EHR data extracts. If your group participates in one or more Medicare Advantage plans, you have likely be asked to create clinical data extracts for payers. TempDev can help you ease the burden of creating these extracts by combing your NextGen EHR data to help you provide the maximum clinical data to payers, regardless of where it was charted. The TempDev Difference TempDev consultants have deep experience helping clinicians and groups participating in Medicare Advantage implement and customize NextGen EHR. TempDev has a broad suite of NextGen template and NextGen reporting solutions to ease your Medicare Advantage reporting burdens and maximize Medicare star ratings and risk adjustment diagnosis coding. For example, TempDev has developed the following Medicare Advantage solutions for clients:
- Patient Status & Stratification Indication
- HCC/RAF Coding Templates & Auditing
- Suspect RAF Coding Templates & Interfaces
- Case Management Templates & Document
- Health Risk Assessment (HRA) Templates, Documents, & Reports
- Integrated Care Plan Templates, Documents, & Interfaces
- Automated Open Order Closure Functionality with Claim Systems & Data Warehouses
- HEDIS Quality Templates & Reports
- Medicare Star Ratings Templates & Reports
- Chronic Conditions Management Templates
- High-Cost Medication Templates
- Medicare Well Visit Templates
- Nursing Home/SNF Templates
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