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Medicare Informatics |
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Medicare Informatics refers to the use of information technology in the administration of Medicare. The goal of Medicare Informatics is to provide high-quality, efficient, and cost-effective health care services to Medicare beneficiaries by increasing efficiency in the Medicare providers and payors. Our solution combines the analytics, clinical, technology, and administrative services needed to make the transition to value-based care.
The interim goal of Medicare Informatics is to prevent major complication diseases by leveraging patient medical data to support more cost-efficient and high-quality patient care. Our ultimate goal is to build a Cloud-based Big Data Analytics Engine by capturing Medicare related interactions between Patients, Providers, and Payors, analyzing collected data, and making continuous improvement in health costs, quality and outcomes.
We observe CMS regulations and guidance.
Improve Patient Experience
Continuously improve patient experience by managing patients through the entire care journey.
Better Health Populations
Improve the access to health care to detect disease early when it is most treatable and curable.
Reduce Medical Cost
Improve outcomes through Clinical Decision Support and compensated for healthy outcomes.
Eligibility Inquiry Service
Real-time access to patient eligibility and benefits information on HIPAA Eligibility Transaction System 270/271.
Electronic Claim Service
[EDI 837] Transmit health care claims and billing payment information electronically, and inquiry claim status.
Preventive Services
Medicare covers a broad range of preventive services to keep you healthy.
Provider Lookup
Medicare-enrolled primary care doctors and other healthcare facilities.
ICD-10 Code Lookup
Lookup the ICD-10 CM (diagnosis) and PCS (procedure) medical billing codes.
HCPC Code Lookup
Lookup the HCPCS (Healthcare Common Procedures Coding System) codes.
HCC Risk Adjustment
Hierarchical Condition Category (HCC) and Risk Adjustment is a payment model which identifies individuals with serious or chronic illness and assigns a risk factor score to them based on the individual’s health conditions and demographics. The risk adjustment scores are then applied by CMS to adjust capitated payments made for beneficiaries enrolled in Medicare Advantage Plans.
QPP/MIPS
The Merit-based Incentive Payment System (MIPS) is one of two tracks (MIPS & Advanced Alternative Payment Models) under the Quality Payment Program (QPP), which moves Medicare Part B providers to a performance-based payment system.
Merit-based Incentive Payment System »
Five-Star Rating
CMS employs a Five-Star rating system to quantify quality and performance for certain plans offered to Medicare beneficiaries. This rating system is used to provide a scored assessment of individual quality components, as well as aggregate overall performance of Medicare Advantage (MA) and/or Prescription Drug Plan (PDP)
