Risk Adjustment

RAPS/EDPS: How fixing errors with the greatest financial impact improves performance

Because of the volume of data involved, EDPS leaves a lot more room for errors. Effective error and workflow management, therefore, is critical if you hope to submit an EDPS file that will pass the Center for Medicare and Medicaid Services’ (CMS) requirements, and if you want to have full confidence that your payment won’t be impacted.

Manage errors based on financial projections
At this point in the year, your MAO may have captured the data it will use for submission. From now until May, you need to detect errors in that data, resolve them and ensure that whatever submission goes to CMS is the best it can be. If you are using an automated system, you may have the ability to detect errors quickly. But what do those errors mean to your bottom line? Creating an error management system allows you to put your resources where they will deliver meaningful financial results.

Prioritize and resolve errors by category and type
You may believe you have to resolve all errors in your submission data. But doing so can keep you from reaching the finish line. Instead, consider the benefits of grouping errors by category and fixing them in order of the impact they will have on your RAF score.

This kind of error management cannot be accomplished manually in a matter of months. You can however, use an automated system to reach your goals. With the following features incorporated into your encounter data application, you will have the tools you need to maintain revenue integrity from your EDPS submissions.

  1. Error identification
    Finding errors in data is a standard feature of most risk adjustment software. But a list of errors, by itself, is not enough. The first step to good error management is being able to make sense of the data you have. You want to be able to sort and categorize data based on multiple criteria, including the top 5 Encounter data errors in 999, 277 and MAO-002.
  2. . Financial Projection
    Being able to see the financial impact of every error will allow you to prioritize the order in which you’ll resolve them. Your program should be able to highlight the errors with greatest HCC impact and provide accurate financial projections for reimbursement based on the particular errors and/or groups of errors you resolve.
  3. Error Queuing
    Once you’ve agreed on where to start, your system should automatically queue errors for resolution and create workflows to help you fix them within the application user interface. Another feature to consider is the ability to queue them for submission or re-submission.If you would like to learn more about Episource’s financial analytics products, please contact us at solutions@episource.com to receive a free consultation. 


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