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Qualified

health data and regulatory expertise

Experts in economic, HIPAA privacy and security,
and regulatory impact on health data for payors,
providers, self-insured, workers comp, and government.
We advise on these contexts as well as agile compliance
via Cloud and DevOps approaches




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Right Way

to Health IT investor diligence

our team has conducted due diligence on > $4 Billion
in healthcare M&A transactions for leading private equity
public investors, and venture capital firms

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Reliable & Effective

expert witness

Medicare Part C / Medicare Advantage

Home/Centers of Excellence/Medicare Part C / Medicare Advantage
Medicare Part C / Medicare Advantage 2017-05-04T04:05:58+00:00

For providers: Risk adjustment advisory services for primary care physicians who are contracted with Medicare Part C plans.

For payors: Industry best practices for Medicare Part C plans to comply with quality and accuracy regulations, namely:

“The Sponsoring Organization’s written contracts with first tier and downstream entities must contain the provisions that contracting providers agree to safeguard beneficiary privacy and confidentiality, consistent with all Federal and State laws, and ensure accuracy of beneficiary medical, health, and enrollment information and records,” as provided for in 42 C.F.R. § 422.118; Manual Ch. 11 – Section 100.4

Services

  • Gain share / quality bonus payments and Medical Loss Ratio calculations
  • HCC Groupings and RAF Score calculations
  • Creating visibility into lawful, legitimate methods to avoid dropped codes and diagnoses that lead to lost revenue

ICD-10 HCC Groups

Mapping of diagnosis codes to HCC groupings under ICD-9 (ICD-10 has different groupings)

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