Retrospective
Risk Adjustment Analyzer
What is ReviewMate HCC Analyzer?
It is a bulk auditing tool that allows you to analyze millions of medical claims from EDI billing files to discover missing HCC diagnoses. The system will provide a detailed summary report with weight impact estimation. This report will be vital in identifying auditing opportunities to recapture missed reimbursements and risk scores.
The analyzer allows you to filter your search by multiple categories, including health plans, service dates, specific facilities or providers, billing type, and more.
Once you discover the potential opportunities, you can use the ReviewMate Auditing Platform (HCC Module) to perform a record-level review of these patients.
Our Risk Manager module allows you to monitor and identify missing HCCs early in the revenue cycle. Click here to read more.
In addition to ReviewMate's standard features for auditing, our HCC module features:
- Overridden HCCs due to the hierarchy structure are identified on the screen so the auditor can readily see which diagnosis codes will be considered into the patient's score.
- Original, revised and net HCC weight for each calendar year.
- Each calendar year for each patient has an “Analyzer” button where the auditor can view what diagnoses and HCCs are missing for a particular calendar year.
All auditing account types are considered part of the core of ReviewMate's auditing system that covers many features such as:
- Customizable settings for analyzing overall accuracy rates. Adjust for particular coders, tasks or firms.
- Built-in code look-up for performing research intuitively.
- Conversations between the auditor and coder are saved in a chronological manner and can be accessed by any user.
- Customizable dashboards to enhance the user experience.
- Identification on the screen of codes with CMS-HCC values.
- Grouping and pricing take place within the software eliminating the need for auditor to "toggle" between an encoder and ReviewMate for better resequencing decisions.
- Full suite of edits/warnings including gender and age conflicts, MCE edits, critical error and TruCode warnings.
- Accuracy rates available real-time and can be sliced and diced to accommodate different situations and date patterns.
- Multiple user levels allow view-only access to any interested parties providing transparency within your organization.
- Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, Clinotes, Principal Diagnosis Analysis, DRG Analysis, and AHA Coding Handbook
- Reconciliation of rebuttals occurs inside of ReviewMate.
- Extensive library of customizable and exportable reports from raw data to Executive Summaries.
- "Audit the Auditor" available for a higher-level quality check of any audit in ReviewMate.