Synergy Computer Solutions Recovers $4 Million
for Large, Multi-site University Hospital in Midwest
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| Synergy Develops Risk Accuracy Function in HMIS to Find Windfall |
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January 24, 2011 (Bingham Farms, Detroit) -- Named among the "Best Hospitals in America" by US News & World Report for five consecutive years, Synergy’s client is a private, nonprofit healthcare organization, which currently owns over 20 hospitals and health centers in the Midwest. The chain of hospitals and health centers is closely tied to a prestigious state university school of medicine, and employs more than half of the schools physicians to practice, supervise and teach residents at its facilities. Additionally, research conducted through the organization leads to the breakthroughs that make a difference in the lives of its patients. |
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| In 2010, Synergy Computer Solutions, a global information technology consulting firm headquartered in Bingham Farms, Detroit, was appointed by the organization to review the risk score accuracy of its physicians in the Medicare Advantage (MA) member program, based on data gathered over the last 2 years. |
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| Risk score accuracy is critical for fiscal management. A non-profit organization like
this requires accuracy in all areas of fiscal management to enable it to continue offering world class patient services and care. |
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| In order to reimburse plans at a level that reflects the cost associated with the health of a plan’s members, CMS (Centers for Medicare and Medicaid Services) uses the Hierarchical Condition Categories (HCC) model to risk-adjust payments to MA plans. The HCC model was developed to capture the health status of the beneficiaries enrolling in MA plans and depends on the submission of accurate and complete encounter data, such as member identifiers and International Classification of Diseases (ICD) at the individual beneficiary level. |
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| Risk Adjustment Data Validation (RADV) is a process used by CMS to verify that diagnosis codes submitted by the plan are supported by documentation in the beneficiary’s
medical record, and involves review of hospital inpatient, outpatient, and physician medical records. RADV audits are also designed to validate the accuracy of the encounter data submitted to CMS and the subsequent accuracy of the payments to the MA plan. |
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| Synergy Computer Solutions developed and integrated an automated plan reporting base
to work with the existing system and ensure accuracy of HCCs submitted to CMS for risk adjustment validation and accurate payment. The new system uncovered $4 million in savings based on underreported HCCs to CMS for 2009 and 2010. |
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| This fiscal windfall is helping its healthcare client channel more funds to fulfill its mission: to improve the health of its patients and community through innovation and excellence in care, education, research and service. |
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| In carrying out its core mission, the organization brings the most advanced patient care to the people who need it, regardless of their ability to pay. In 2009, they provided more than $96 million in charity care - free or reduced-cost medical care delivered to low-income individuals. The organization also trained the next generation of physicians, engaged in thousands of clinical trials researching breakthrough treatments and partnered with hundreds of community organizations to bring health and wellness education to people throughout the state. |
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| According to Jeff Petrusha, Vice President at Synergy “We are pleased to be able to provide support to our esteemed healthcare industry client, that will enable the fulfillment of its vital mission. We will continue to provide business and information technology consulting services to uncover more ways to improve overall operations and reduce costs”. |
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