Finally, a solution for receiving and distributing paid claims data.

Beth can pickup any amount of data, organize it, and push it into physician systems.

Empowering your ACO growth by:

Distributing Patient Data to PCPs

Identifying Cost Saving Opportunities

Ensuring Accurate Risk Scoring

Simplifying Quality Reporting Data Submission

Supporting Custom Predictive Algorithms

We used to struggle to make payroll when payers would change the rules and our AR would build up. Now I can focus on our strategic goals without worrying about revenue leakage. 

Chief Financial Officer

Recruiting and keeping good staff has been a challenge for years. Now that I can keep things running smoothly I can focus on keeping the best staff and investing in leadership training. Chief Operations Officer

I don’t have to worry about getting my vendors to integrate with each other. RCM Brain gives me scalability and interoperability that I have never had before. Chief Technology Officer

Receiving and distributing paid claims data requires
nothing less than grueling labor from your ACO team.
This can interfere with reaching your ultimate goal of
providing better care for patients at a lower cost.

At RCM Brain, we created Beth to help your ACO work around the arduous task of data processing and submission. She can:

 

  • Pick up any amount of data
  • Organize data more precisely and efficiently than any team can
  • Push data directly into physician systems

 

To learn more about what an asset Beth can be for your ACO’s growth, read on. Or you can call us at 1-855-RCM-BETH or fill out our handy online form to schedule a consultation with a member of our team of experts.

This will allow your ACO to foster better patient health, save money, and result in better informed primary care physicians.

Distribute Patient Data to PCPs

Since their conception, ACOs have been struggling to connect the dots between:

  • The information payers know about a patient
  • The patient’s various medical care providers, and
  • The patient’s primary care physician

Without this comprehensive knowledge, primary care physicians have a much harder time helping patients achieve and maintain optimum wellness. PCP’s regularly receive important information after it’s too late to make a difference. This makes it nearly impossible for ACO’s to reduce the cost of care while improving health and wellness.

But if your ACO adds Beth to the team, she can:

  • Collect paid claims data from any combination of payers
  • Process the information collected from the claims data
  • Push relevant pieces of information back into the PCP’s practice management and EHR systems

Identify Cost Saving Opportunities

Currently, primary care providers are not equipped with tools to identify where cost saving opportunities exist. For example, if it would be more cost-effective for a patient to get services from a durable medical equipment (DME) provider instead of a hospital, the primary care physician has no way of knowing this information.

Providers would have to sort through a mountain of data supplied by payers to even try to identify cost-saving opportunities. And this task only becomes more difficult when attempted at the patient level.

But when you decide to make Beth part of your ACO’s team, she can look at the historical data of every patient, the combination of services they have received, and the combination of providers from whom the patient received those services.

In doing so, Beth can perform predictive cost management, immediately identifying saving opportunities that exist at the patient level because she will know if certain providers in a patient’s network overcharge for certain services.

The management of risk scoring is one of the most important and underutilized tools that a primary care provider has when managing a population of patients.

Ensure Accurate Risk Scoring

Risk scoring in reference to Medicare patients is often called hierarchical condition categories (HCC) risk. Basically, this is a way of acknowledging that how sick a patient is, or how sick a patient is described as being in the records, can significantly impact the expected amount of money to be spent on that patient. Particularly when the PCP is being incentivized to save money or improve quality of care.

For example, consider a patient that has diabetes, but their condition is well-managed. Perhaps they come into your office for an unrelated health reason and you neglect to note their diabetes diagnosis on a claim. In response, the  insurance company will lower the overall risk score that has been applied to set the budget for that patient.

Due to this miscommunication, a well-managed high-risk patient will get re-scored by the insurance company as lower risk, although they still require a certain degree of care related to their diabetes. This diminishes the cost savings your wellness program was able to achieve by keeping your patient healthy.

To avoid this situation and improve the accuracy of risk scoring, Beth will scrub every claim before submission to payers so she can:

  • Identify missing diagnosis codes that should be applied or may need to be applied by your coding staff
  • Make sure risk scores are not under-reported by primary care providers

Simplify Quality Reporting Data Submission

Another major obstacle that ACOs face is reporting quality data back to the individual payers. While some payers have made this easy by only requiring reports on claim data, other payers have made it more challenging by requiring clinical data points from the EHR, such as:

  • Blood pressure
  • Body weight
  • LDL levels

Currently, your ACO team must complete all of this reporting manually, which takes hundreds or even thousands of hours and frequently results in innumerable errors and mistakes.

Instead of having your staff manually complete these tasks, you can have Beth:

  • Retrieve all of the necessary data from within the EHRs
  • Compile all of this information into a reporting package
  • Review and scrub all data reporting before submission

Support Custom Predictive Algorithms

In the near future, ACOs may move away from supporting upside-only risk-based contracts. They could begin to implement a world of downside risk with their insurance payers. Cost savings would be required, instead of just being bonused.

As this occurs, the goal of identifying patients and rerouting them to the most cost-effective provider will become hypercritical. Because every mix of providers and services is geographically unique to an individual ACO network, there is no current one-size-fits-all solution for this situation.

Beth will be an indispensable member of your team in this transition because she is trained to identify and support your ever-changing and expanding niche of providers who are performing various services. Beth will determine and support the custom algorithms needed to route patient care most effectively in your specific network.

Hire Beth Today and Watch Your ACO Grow.
Beth may seem too good to be true, but her performance will speak for itself. For a personal consultation where you can learn more and ask the RCM Brain team questions, call 1-855-RCM-BETH.

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