August 2010
Asuris TruAdvantageTM to pilot prospective risk adjustment through in-home assessments
Beginning in September, we are piloting a prospective Medicare risk adjustment program to enhance our ability to capture the risk adjustment data for our Asuris TruAdvantage members.
Selected Asuris TruAdvantage members will be contacted by MEDXM, our contracted vendor for this program, to schedule an in-home assessment. MEDXM physicians are:
- Medicare participating physicians
- Trained in Hierarchical Condition Category (HCC) coding
Upon completion of the assessment, MEDXM provides us with a detailed report. We will share the report with his or her primary care provider, if the member requests. There is no cost to the member to participate in the assessment, and it is not a substitute for any care you provide to our Asuris TruAdvantage members.
Some of our objectives for this program are to:
- Create a positive member experience
- Diminish the need for retrospective chart reviews over time
- Refer members for case management and/or disease management, if appropriate
- Educate members about the importance of adherence to prescribed treatment plans
- Report accurate risk adjustment information to the Centers for Medicare & Medicaid Services (CMS)
- Document the medical management of all existing member specific medical conditions in a manner that satisfies the CMS risk adjustment data validation criteria
- Conduct a comprehensive annual update of the member's medical record including:
- Review current medications
- Document current treatment plans
- Document all existing and past medical conditions
- Provide appropriate additional tests, such as diagnostic laboratory tests and spirometry