Timely, Accurate Revenue Management Reporting
You have decided on a set of revenue management strategies. These strategies probably include medical record reviews, in-home or in-office assessments, provider detailing, or other outreach activities. But do you have monthly estimates of your revenue from these activities coupled with the routine submission of RAPS and EDS data?
Better Predict Your Payment Updates
If you are Medicare Advantage plan, do you know what your revenue is likely to be at the next payment update (e.g., the July mid-year update)? If you are an exchange issuer, do you have estimates of your nominal risk score and an assessment of how this risk score compares to competitors in your state?
Mile High Healthcare Consulting can provide regular revenue management reports, stratified all the way down to the provider level. Providers can see their total risk score from all data, not just the data slice derived from their own activities. The reporting can include peer-based and/or plan-wide comparisons.
A key feature of comprehensive revenue management reporting is the ability to attribute risk scores to the revenue management strategies. Mile High’s reporting can show how each revenue management intervention is contributing to your overall risk score. We use multivariate statistics for observational data, such as propensity score matching, to estimate the effect of a revenue management intervention by accounting for the underlying data flows from routine data submission processes. Propensity Score Matching attempts to reduce the bias that can occur if one attributes all of the revenue increase solely to a single revenue management intervention. It also allows a fair comparison (by controlling for confounding variables) of two groups of members—such as those that received the revenue management intervention (e.g., a completed in-home assessment) being compared to a group of members that did not receive an in-home assessment.
Medicaid Revenue Management
Mile High Healthcare Consulting also supports revenue management reporting for Medicaid managed care organizations. Risk score calculation is radically different in Medicaid, relying on the historical health plan risk score, instead of an individual member risk score. The MHHC team has been working with Medicaid risk adjustment since the 1990’s and understands all of its nuances and how it differs from Medicare Advantage and Exchange risk adjustment.