APM | Alternative Payment Models
As the healthcare industry evolves toward value-based payment, our team brings extensive experience with prior Centers for Medicare & Medicaid Services (CMS) models, including Comprehensive Care for Joint Replacement (CJR), Kidney Care First (KCF), and Bundled Payments for Care Improvement Advanced (BPCI-A). This insight extends to our current Alternative Payment Models (APMs), empowering your healthcare organization to leverage data for a deeper understanding of performance drivers while streamlining and coordinating care. Our products include solutions focused on:
- Enhancing Oncology Model (EOM): CMS designed EOM to test how to improve your ability to deliver care centered around patients, consider your unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes.
- Kidney Care Choices (KCC): This model is a Medicare value-based care program developed by CMS to enhance care for patients with late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD). The program leverages accountable care organizations (ACOs) to incentivize providers to delay dialysis, promote home dialysis, increase kidney transplants, and improve patient education. By shifting from a fee-for-service model to one centered on quality and outcomes, KCC aims to improve care and results for Medicare beneficiaries.
- Medicare Shared Savings Program (MSSP): This program analyzes detailed and summarized data for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP), providing timely and meaningful information to help improve individual and population health and reduce the cost of care. MSSP can help your clinics, plus physician and hospital organizations, implement and evaluate new delivery models to better understand their impact on the health, quality, and financial viability of the local community and healthcare delivery system. It utilizes CMS’ quarterly Medicare claims data feed to generate Medicare Spend per Beneficiary Analytics to help improve clinical disease management strategies and network performance. The MSSP aims to shift Medicare toward value-based care, rewarding quality and efficiency over the volume of services.
- Transforming Episode Accountability Model (TEAM): A mandatory bundled payment program focused on beneficiaries undergoing certain high-expenditure, high-volume surgical procedures. It aims to produce higher quality, more coordinated healthcare at a lower cost to Medicare by incentivizing hospitals to assume accountability for the total costs of care during a specified “episode.”
ChaRT | Clinical Documentation Improvement Review Tool
This solution is a bi-directional communication tool for clinical documentation improvement. ChaRT helps you identify charts for review by a Forvis Mazars team. The review captures additional information and potential coding adjustments. Afterwards, notification is sent to you so you can agree or disagree with Forvis Mazars feedback and generate reports based on the review process. ChaRT is available for inpatient DRG and HCC review, as well as outpatient ICD-10 and Procedure code evaluation.
Denials Management Monitoring
This platform can help your organization identify trends in your denials and resolve issues. It’s not meant to be a task queue but a way to better understand your denied claims and enable informed decisions that can help prevent new denials.
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Employee Benefit Plan
Many self-insured organizations don’t get the insights needed to understand and manage healthcare expenditures from routine third-party administrator (TPA) reports. Our employee benefit plan solution scans healthcare claims to deliver analytics that measure and monitor your performance based on membership, utilization, spend, and quality.
Exclusion Testing
Exclusion Testing is a monthly service that can help your organization stay up on regulatory compliance. Hospital associates, pharmacies, and vendors can be placed on federal and state exclusion lists for a variety of reasons. Exclusion Testing compares your data to publicly available federal and state exclusion lists. Any flagged matches due to address, name, or NPI are manually reviewed by our team using agreed-upon criteria and presented to you as a monthly deliverable.
Fair Market Value
Fair Market Value assesses how your hospital or hospital network’s physician compensation compares to market value by studying compensation and wRVUs and assigning a score for overall risk. You can review this comparison on an individual basis or by department. Department comparisons provide the departmental national average and your hospital’s average.
Hospital Quality & Efficiency Program (HQEP)
An HQEP is a contractual agreement between a health system and a Clinically Integrated Network or Accountable Care Organization for achieving quality improvements and cost reductions within the inpatient setting and/or employee population. Our analytics measure your performance against agreed-on KPIs.
