See how we can help you reach the highest levels of compliance and profitability with the use of ReconEdge™, our secure, web-based financial reconciliation system.

Revenue Cycle Management

Managed care plans and other health care organizations are required to reconcile their Medicare enrollment data and payments to ensure compliance with CMS. Due to the complexity of CMS payment methodology, plans may lose up to 15% of their CMS monthly premium payments.

Health Risk Partners can assess your organization's opportunities and recommend strategies for reaching your performance objectives. Our compliance-based consulting services include:

Membership and Premium Reconciliation
Risk Adjustment Encounter Processing
Risk Score Modeling and Receivable Calculation
Part D Financial Reconciliation
Health Care Conditions (HCC) and Diagnoses Auditing
Revenue Maximization and Recovery
Outsourcing and Chart Review Services

See how we've helped our other clients:

+ Risk Score Increase	+ HCC Recovery
A major national health plan client with more than five years of experience with HRP, has increased their risk score from 82% to 100% through improved analytics and provider reporting.	A health plan working with HRP is projected to recover $1.8 million from a chart review project of about 4,000 members.
+ Part D Audits of Claims	+ Receivable Calculations
Through the usage of ReconEdge’s PDE reporting, a client recently discovered that over 1/3 of their PDE claims have been incorrectly populated by their PBM. Additionally, the system has report millions of dollars of unresolved PDE errors which the plan is now working to correct.	Most ReconEdge clients use the system to book receivable estimates for the payment year final reconciliation, the mid year update, and the Part D final reconciliation. Several clients have had these receivables audited by a third party accounting firm. A recent audit of individual risk scores and payment estimates validated HRP calculations at 100% accuracy.
+ Enrollment Reconciliation	+ Letters Generation
ReconQ, the user friendly enrollment discprepancy tracking, is in use by all HRP system clients. One client reduced discrepancies for 2006 from over 3,000 members to less than 200 members. This plan also uses a handy “batch back” utility to expeditiously send corrected enrollments back to CMS.	Several clients of HRP use our Transaction Reply Report utility for the management of their Transaction Reply Report. They have customized letter generation that allows them to send member correspondence at the click of a button.
+ Reporting Gaps	+ RAPS Compliance
A client requested that HRP produced the Acumen file for the reporting of LIS members to CMS. Within 3 weeks, HRP turned this around for the client, and now all HRP clients have this reporting capability with the click of a button.	CMS has become very stringent about sending duplicate RAPS data. HRP filters for duplicates on all RAPS files prepared. Also, HRP sends a monthly notice to Clients to let them know what their percentage of dups for the last 90 days has been.