Healthcare organizations are facing revenue recovery problems caused by
- supply shortages,
- labor costs,
- payer challenges,
- the Covid-19 pandemic, and
In addition, audit risk is not just a legal issue but a financial one. For example, a typical RADV audit costs approximately $500,000.
To overcome these challenges, Fi-Med worked with hospitals and created revealMD RAF, a Predictive Analytics technology that enables healthcare organizations to quickly identify revenue and risk in their Medicare Advantage and Risk-Based contracts.
With a few clicks, the software identifies missed revenue opportunities. Including:
- Patients seen with HCC Gaps in Care.
- Unseen patients with HCC Gaps in Care.
- HCC Gaps in Care at the organizational level by Specialty, Provider, patient, and codes.
- Providers using codes with no Risk Adjustment Factor score resulting in non-reimbursement.
- HCC Coding with revenue loss, and if documentation supports it, suggestions for coding that will result in reimbursement.
- HCC Coding with audit risk.
A Real Life Example
Before using revealMD RAF, it took one Compliance Auditor working in their EHR four hours to find and prepare just ten patients with HCC Gaps in Care.
After 30 minutes using revealMD RAF, one Compliance Auditor viewed all 700 of their Providers and over 91,000 patients, identifying the top 10 patients with the most significant HCC Gaps in Care. revealMD RAF eliminated the need to use EHR for gap identification, achieving an 800% improvement in productivity. In addition, it identified over $24 million in revenue potential over the previous year.
- Overcome the limitations of EHRs,
- improve staff productivity,
- eliminate the need to hire additional staff for audits, and
- spend more time educating and working with Providers to recover revenue instead of tediously pulling charts.