Care at Home
Providers & payors
CINQCARE and Cinq Connect IPA and ACO bring you Quality Risk Adjustment Solutions.
We offer Payors and Network Primary Care Providers a full life cycle of solutions to improve Medicare HHC scores, and Medicaid Risk Adjustment, with an added emphasis on data capture for HEDIS and STAR measures.
Technical consultation is offered, and Payers and Provider can choose from one or all of our solutions.
Services Include:
- Data Analytics to assess claim coding and medical expense in order to prioritize which practices would benefit from improved risk scores.
Prospective
- Coding Alerts for surfacing to Practices conditions for risk adjustment evaluation.
- Patient Assessment Form generation with suspect conditions and recapture codes deployed within common EMRs, or manually, at the point of care for practitioner decision support.
Concurrent
- Short-term Staff Support to process Patient Assessment Forms with providers, complete Payer diagnostic attestations and/or submit visit documentation.
- Interim Medical Record Review and Claim Coding Support Prior to Claim Submission, as closer to real time feedback is often one of the most effective means of learning.
Retrospective
- Audit of Medical Record Documentation and Medical Claims Coding, with audit results report feedback to practices and providers.
- Practice Performance Improvement Plan Development, including assistance with plan execution and evaluation of completion.
- Staff training on clinical-diagnostic assessment, documentation, and coding across a range of staff roles, with tools and techniques provided.
Our Annual Comprehensive Assessment Visit Program under our Care at Home Medical Practice is also designed to assess suspect conditions and recapture codes as well as close quality gaps in care. A Nurse Practitioner or Physician provides a thorough assessment via telehealth or an in-home visit, a copy including care plan recommendations is sent to the PCP and a claim is submitted to the Payer with all the appliable service and diagnostic codes.
The Q In Cinq
Our risk adjustment solutions address the needs of practices and health plans to also meet quality objectives such as identification in medical records of where gaps in care have been met, and where member meets exclusionary criteria for quality measures.
- Our feedback also includes where code capture for HEDIS and STAR measures.
- Any discovery of inappropriate variation from medical guidelines is promptly escalated for a quality-of-care review.
Value Proposition
Two of our goals in ensuring documentation and claims codes accurately reflect all of the demographic, and psycho-social characteristics as well as the medical conditions of the population served are:
- so that regulators apply accurate risk adjustment and with that ultimately premium payments are right sized for medical expenses.
- to support more accurate population health risk stratification and in turn more appropriate community intervention and more effective clinical program development and deployment.
- In this regard, our quality risk adjustment reviews include identification of opportunities to query, code and address social determinants of health as well as potential Adverse Childhood Experiences.
These goals are key to meeting the CINQCARE mission of addressing and irradicating health care disparities particularly in the black and brown community as well as in geographically underserved areas.
To inquire about contracting as a Payor or as a Provider with Cinq Connect contact 844-401-4663
844-401-4663
