CodePoint by Episource is our proprietary software platform allowing our coders and clients to easily and efficiently view medical records, audit charts, and generate valuable analytics and reports. With its unmatched transparency, CodePoint allows clients to step right into EpiSource’s coding process and review codes on a chart by chart basis. Have a question about a particular code? We don’t have to tell you where it came from, with CodePoint, we can show you.

Chart reviews provide a treasure trove of data on individual patients, patient populations, medical conditions and physicians. CodePoint’s reporting engine allows you to take control of this data in a matter of clicks with the option to create your own custom reports. We have the data to tell you how your physicians are coding and documenting care under the risk adjustment model, what new HCCs were captured as well as codes incorrectly submitted by them, and the ability to link validated HCCs with copies of the medical record to support your RADV processes– and through CodePoint – that data becomes yours, allowing you effectively manage and improve the quality of your Risk Adjustment program.

Overview:

Episource helps Health Plans prepare for CMS Risk Adjustment Data Validation (RADV) audits by providing mock RADV audit services.
Episource has a proven approach to meeting Risk Adjustment Data Validation (RADV) requirements. This method includes the following steps:

• Analyze and sort patients and Hierarchical Condition Categories (HCCs) to be validated.
• Target providers with documentation most likely to support these HCCs via analysis of claims data and/or Accepted RAPS data which includes diagnosis codes from the target HCCs.
• Collect these primary records, including all documentation for services in the target year.
• Review primary records for support of the target HCCs based on CMS and Coding Clinic guidelines.
• As necessary, select secondary providers (those whom the member has seen but whose claims did not include diagnosis codes from the target HCCs).
• Retrieve and review secondary records.
• Deliver completed CMS RADV Audit results as required.

Key differentiators:

Access to online Codepoint portal for

• Comprehensive status reporting package (Project Status, Current and Projected retrieval schedule, Issues, Outreach details)
• Real-time alerts when a provider is not cooperating with retrieval
• Import encounter data files for easy data validation at the time of coding
• Quick access to copies of medical record linked to validated HCCs at provider, member, code, and date of service levels
• Real-time, 24×7 access to project status, chart-by-chart retrieval and coding validation status, provider communication logs, and status reports

Overview:

Using an integrated global delivery methodology, with onshore and offshore Medical Professionals, Clinicians, and Certified Coders, Episource is able to provide extensive and quality Medical Chart Audit Services with significant cost savings to increase ROI on organizations’ Risk Adjustment Programs

Coding Services

• Certified/clinical coders (CPC) for in-depth focused Retrospective Chart Reviews
• Data Validation Audits (from encounter files) at the time of coding
• Key coding and documentation errors highlighted
• Part C (HCC) and Part D (Rx HCC) Coding – Best HCCs or Encounter-Wise
• Physician Chart Audit summary reports for HCC coding improvement opportunities and education
• Concurrent Coding
• Coding Annual and Prospective Health Assessment forms
• Review from EMR Systems

Key differentiators:

• Average ROI – 8:1
• RADV Risk Mitigation
• Powerful analytics on chart audit data
• 2 sets of coding reviews – 100% Audit on coded charts using a separate QA team to ensure accuracy and quality of HCC code capture
• Over 50% savings in coding costs through our global delivery methodology
• Access to experienced CPC Certified Coders with strong medical backgrounds

Click here to get your free pilot program set up or call us at (866) 885-7696.

Episource’s goal is to integrate our expertise in different aspects of health care operations to improve quality of care and increase business process efficiencies. Our team has comprehensive experience in assessing and developing improvement projects for Medicare Star measures. The team achieves this by measuring the current status, identifying a subset of key measures to focus on and establishing goals for those measures. We works closely with health plans to develop, implement, and monitor quality improvement programs to attain established goals. Quality improvement programs are developed keeping in mind the triple aim of:

• Improving quality of care
• Improving patient satisfaction
• Decreasing cost of care

In addition to that, our team has extensive experience in HEDIS audit preparation, reporting and analytics for HEDIS, HOS, and CAHPS measures. Our consultants have also led a health plans to successful NCQA and AAAHC-Medicare Deemed accreditation surveys.

Core Competencies:

CMS Star Program: Development and implementation of Medicare Star Program measures to maximize reimbursement from CMS. Our strategies include but are not limited to the following:

• Complete gap analysis for all reportable star measures.
• Detailed analysis of HEDIS, HOS, and CAHPS survey results for applicable star measures.
• Analysis includes both quantitative and qualitative analysis.
• Quantitative analysis includes tests of statistical significance, trend analysis, benchmarking results, etc.
• Qualitative analysis includes detailed barrier analysis, attribution analysis, cost benefit and effectiveness analysis, etc.
• Detailed analysis of all the Health Plan measures (telephone access, Part D measures, etc).
• Discussion with relevant health plan staff and review of other studies to understand barriers (e.g. access and availability, cultural and linguistic assessment, group needs assessment, etc)
• Review of non-reportable measures to identify opportunities for changing reportable status.
• Developing reports that allow Plans to monitor star rating for HEDIS measures and other reportable star measures on a real time basis.
• Developing provider and member level report for HEDIS and other reportable star measures.
• Working with Plans to develop and implement interventions at multiple levels.
• Health Plan level interventions – e.g. improving data collection and reporting, member outreach strategies, provider outreach strategies, incentive programs, improvement in reporting, enhanced use of technology, etc.
• Provider level interventions – e.g. report cards, gaps in care lists, incentive programs, provider communication, review of payment models (Capitated versus fee-for-service), etc.
• Member/patient level intervention – e.g. member incentive programs, outreach and education programs, review of benefit structure, improving access and availability of providers/services, tools to measures member satisfaction on an ongoing basis, etc.

Ongoing HEDIS Medical Record Abstraction to improve Star Ratings

Episource leverages its experienced Risk Adjustment coding teams to abstract HEDIS measures at the same time as the HCC Chart Review process. This service allows Health Plans and Medical groups to capture important risk adjustment and HEDIS data at the same time for improving RAF scores and quality of care measures.

Overview of Services:

1. Measures for medical record data collection:

Breast Cancer Screening, Colorectal Cancer Screening, LDL Testing for Cardiovascular Conditions,, Glaucoma Testing, Adult BMI, Diabetes LDL Testing, Diabetes LDL Control, Diabetes A1c Control, Diabetes Nephropathy Care, Diabetes Eye Exam, COA Medication Review, COA Functional Status Assessment, COA Pain Screening, Controlling Blood Pressure

2. Establishing HEDIS eligible population and administrative complaint members

3. Medical record retrieval activities for non-compliant members.

4. Medical record abstraction on collected medical records.

5. Over-read and Validation

6. Final Supplemental Encounter data

Episource aims to help health plans improve the overall quality of member care through proactively offering comprehensive home health assessments to identify gaps in care, capture risk adjustment data, and improving quality care through Star/HEDIS measures

Episource will utilize fully-licensed and credentialed mid-level healthcare providers (NPs and PAs) to complete an approximately 1 hour health assessment, which will include:

• Review of medical history and related complications
• Examination of vitals
• Examination of systems
• Review of medication
• Activities of daily living assessment
• Health Maintenance assessment
• Assessment of diabetes and related complications
• Fall risk assessment
• Nutritional assessment
• Depression screening
• Lab Specimen collection prior to each visit

All assessments are reviewed by Medical Directors (MDs) to ensure quality and are coded by Episource’s team of certified medical coders for accurate risk adjustment data submission.
Episource will submit all completed home health assessments to the health plan as well as a brief summary of each visit to be shared with the member’s PCP.

Key Benefits of the Program

• RADV Risk Mitigation with accurate documentation and coding
• Improvement in RAF scores with additional HCC/RxHCC capture
• Identify gaps in care for key HEDIS/Star Measures
• Identify problems with medication adherence (for Part D Star Measures)
• Capture feedback from members on overall health plan satisfaction that drives CAHPS/HOS survey scores
• High quantifiable ROI

Episource provides quality data entry services to handle complex financial accounting processing using on-demand technology platforms. Leveraged through local and international resources, Episource processes accounts payable and purchase order transactions through scanned copies of invoices that are stored online. Resources are skilled in accounting norms and are known for their strong data processing capabilities. And our core client base is situated in the multi-family industry using spend management systems.

Invoice Processing Services

Our Services Include

• Automated Invoice Processing
• 24 Hr turn-around-time
• Eliminate paper-based systems
• Over 60% savings in invoice processing costs
• Data Extraction based on customized rules
• Utility and Telecom Bill processing
• 100% Quality Audit on Data Entry
• Call Center capabilities for handling errors on invoices

For More Information, call 714-452-1961, or email us at dataentry@episource.com

Utilizing a diverse array of resources to provide you with 24/7 support, Episource leverages a unique combination of domestic and international Clinicians, Medical Professionals and Certified Coders. We offer remote medical coding support and auditing services for facilities and physicians to help improve your bottom line through outsourced efficiency. We can even scan medical records onsite, and code all charts with scanned copies available online.

Remote Facility Coding Services

• Inpatient (Medicare, Non-Medicare, CMS DRG & APR-DRG)
• Outpatient Surgery
• Outpatient Services including Observation
• Emergency Services (with or without E&M assignment)
• Inpatient or Outpatient Rehabilitation setting
• Nursing home and long-term care setting
• Inpatient or Outpatient Psychiatric setting
• Home Health Agencies

Remote Physician Coding Services

• All specialties
• Office/Clinic setting
• Outpatient or Inpatient professional services
• Urgent Care Centers
• Radiology Centers
• E&M Services

Key Deliverables

• Summary of Findings for each physician
• Statistical analysis of key coding errors
• Accurate code capture through 100% Audit
• Reporting tools to help with provider coding education