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Your solution in mastering the blended V24-V28 CMS-HCC model.
Why Should You Adopt V28 Early?
On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) announced that they will be gradually transitioning to the V28 CMS-HCC model by 2025. Since then, our experts have been hard at work to develop a new version of our existing analytics platform, Episource Analyst, that will help your organization seamlessly transition despite the model’s numerous changes.
The V28 model is expected to decrease Medicare Advantage risk scores by an average of 3.56% in 2024. Thus, early adoption of the blended model is crucial. Episource Analyst can help you plan ahead by:
- Analyzing how the new model will impact your organization. Our analytics technology ingests your member data to estimate the potential decrease in risk scores and RAF opportunities for your risk adjustment program.
- Providing a more accurate risk assessment of your member population based on the changes to unique HCCs and HCC mapping.
- Delivering recommendations on strategies for counteracting the decline in risk scores, such as developing prospective care programs and improving member engagement through our Risk Adjustment Program Assessment service.
Key Features
Risk Adjustment Suspecting
Leverage risk adjustment suspecting and gap analytics based on historical data with simple workflows to manage prospective, concurrent, and retrospective campaigns.
Chase Lists
Generate chase lists by prioritizing high-risk members for more immediate care.
Member & Provider Stratification
Stratify members and providers by numerous data points and attributes, including risk scores, disease gaps, prevalence, eligibility, provider types, and more for direct, targeted impact at campaign or program levels.
Streamlined UI
Customize your member- and provider-level reports and easily view campaign performance metrics, such as total eligible members and top 5 suspected and captured HCCs with our intuitive UI.
Our Impact
"...When you establish a new relationship, you set some expectations, and some are lacking, some just meet expectations, and then you have that one or two who will exceed expectations — and that is Episource for us."
"You guys have put thought into things and understand risk. It's not just risk scores, it is so much more."
"Seeing the impact that we have on our providers has made it all worth it."
Experience seamless V24-V28 model adoption with Episource Analyst.
Even if your organization isn’t ready to adopt a new analytics solution, we can still partner with you on any of your other risk adjustment needs. Episource offers an end-to-end platform that includes medical record retrieval, medical chart coding and submissions. Explore our website and contact us to learn more.
Additional Resources
Streamlining Healthcare Coding and Enhancing Revenue Forecasting in the Face of the CMS-HCC V28 Model Transition
Shortly after the version 28 of the Hierarchical Condition Category (HCC) model was announced, Episource engaged with a diverse group of small- to medium-sized health plan clients facing the challenge of transitioning to the newly blended V24-V28 model. Since the average risk score decrease expected with this blended model is 3.56% in CY 2024, we helped these organizations adapt to the latest coding methodologies for risk adjustment and revenue forecasting.