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Key Terms | Solution Features

 

 

Patient Header

Travel: Indicates if the patient has claims in multiple states in the last 120 days and is populated with a list of states in which the patient has had claims.

Covid-19 High Risk – Yes or No flag to indicate the patient meets the Covid-19 High Risk has underlying conditions, medication adherence issues and other high-risk factors.

Avoidable Emergency Visits – Yes or No flag to indicate if the patient has had an Emergency Department Visit that would be considered Avoidable under the Health Endeavors Avoidable Emergency Department algorithm.

Palliative Care – A Yes or No indicator to flag the patient as Potentially Eligible for Palliative Care. The criteria include terminal diseases, serious chronic conditions and Emergency Departments visits and is intended to show patients seriously ill who are utilizing the Emergency Room as a primary care office.

Quick Profile

2019 (2020) vs 2018 (2019) HCC DX – Compares HCC diagnoses in the current year to the previous year to aid in recoding efforts. Patient risk scores are calculated from patient demographics and HCC diagnoses. A higher score indicates the patient is at a higher level of risk than that of a patient with a lower risk score.  The end-user may drill into the diagnoses to determine the diagnosing provider.

2019 (2020) vs 2018 (2019) Medications – Compares medications prescribed in the current year to the previous year.

Current Diagnosis List (ICD-10) – The current year diagnosis codes as derived from the patient’s adjudicated claims.

Cost and Utilization - identifies high-cost utilization such as emergency department, admission, re-admission or imaging.  The end-user may drill into the encounter to determine the provider and place of service.

Quality Care Gaps – If the patient is enrolled in a quality program, the list of measures will populate with an indication of action required, not applicable, or done.

 

HCC Coding Assist – HCC DX

Code – The ICD-9/ICD-10 code of which the patient has been diagnosed

Code Description – The definition of the ICD-9/ICD-10 code the patient has been diagnosed with

 

Date of First Billing – The date of the first encounter in which the patient was diagnosed with the ICD code

 

Date of Last Billing – The date of the most recent encounter in which the patient was diagnosed with the ICD code

 

Total Count of Claims – The total number of times the diagnosis has appeared in the patients claims.

 

Rendering Provider Name and NPI – The legal name and National Provider Identification number of the provider who most recently diagnosed the patient with the condition

 

HCC Code Details – Current Diagnosis List

HCC Code – The HCC code within the hierarchy of disease progression for the selected diagnosis.

 

Description – The definition of the HCC code within the hierarchy of disease progression for the selected diagnosis.

 

Weight – The HCC coefficient assigned to the listed HCC score for an aged, non-dual beneficiary. This should not be used as an absolute increase for billing the related code but rather to get a sense of weight when comparing similar HCC categories. A higher score indicates a higher level of risk, and therefor a greater benchmark for predicted spend.

 

ICD Code – The ICD-10 codes that relate to the chosen HCC code.

 

ICD Description – The definition of the ICD-10 codes that relate to the chosen HCC code.

 

Cost and Utilization

2019 (2020) YTD Spend – The sum of paid claims in 2019 (2020).

2019 (2020) HCC Benchmark – A financial spend benchmark based on the patient’s HCC score and demographics.

2019 (2020) HCC Benchmark vs 2019 (2020) YTD Spend – Percentage of financial spend benchmark used year to date. What has been spent vs what is left.

Benchmark Prediction – A warning symbol to indicate if the Health Endeavors Algorithm predicts if the patient will exceed their benchmark before the end of the current year.

Out of Network Spend – The sum of paid claims for the current year billed by providers who are considered out of network per the configuration of your account.

Office Visits – A listing of dates in which the patient had an encounter that is considered an office visit.

 

Most Visited Provider – The NPI and name of the provider the patient has encounters with most frequently

Admits - Number of times in which the patient has been admitted during the current year.

 

Readmissions - Number of times in which the patient was discharged and within 30 days, readmitted to a hospital during the current year.

ED Visits – The number of times in which the patient has had an encounter considered to be an Emergency Department Visit during the current year.

ED Visits that led to Hospitalizations – The number of times in which the patient had an Emergency Department Visit and was admitted as a result of the ED Visit during the current year.

CT Scans – The number of CT Scans for the patient during the current year.

MRI Events – The number of MRI Events for the patient during the current year.

Patient History (4-Year)

Out-of-Network is determined by your network setup.

 

Dual Eligible – Indicates if the patient is dually eligible for Medicare and Medicaid benefits.

Medicare Status Code – Indicates how the beneficiary became eligible for Medicare benefits.

HCC Trend – The patient’s HCC score trended over a four-year period. HCC Scores are calculated from patient demographics and specific diagnoses to calculate a patient risk score. A larger score indicates the patient to be a higher level of risk than that of a patient with a lower risk score.

Claims History – A rolling 12-month period to provide an overview of the patient’s financial spend.

Part A Claims – The beneficiaries’ sum of claims in the current calendar year that are billed by a facility or agency covered under Part A benefits.

Part B Claims - The beneficiaries’ sum of claims in the current calendar year that are billed by providers for things such as outpatient care, preventative services, ambulance services, and laboratory services under Part B benefits.

Part B DME Claims - The beneficiaries’ sum of claims in the current calendar year for durable medical equipment for things such as oxygen, canes, or infusion pumps that are billed under Part B DME benefits.

 

Part D Claims – The beneficiaries’ sum of claims in the current calendar year that are billed and covered under Part D benefits. Blank if the patient is not enrolled in Part D

Patient Contact Details

Text Alert Enrollment - allows the healthcare provider to send an enrollment request to the patient to enroll in wellness and quality text or email notifications.

 

Data Sharing – Details if the beneficiary has opted out of sharing their data and if claims data was ever received. This section will also detail the reason the beneficiary opted out such as the beneficiary was excluded by CMS or if the beneficiary is to decline.

Health History Form

Health History DX – A list of diagnoses codes found within the patient’s adjudicated claims data and has been supplied to the patient to denote which conditions the patient may not be aware of, managing, not managing, or feels that management is not required.

Diagnosing Provider – The provider who billed the first instance of the associated diagnosis code.

Health History Medications - A list of medications found within the patient’s adjudicated claims data and has been supplied to the patient to denote which medications the patient is taking, not taking, and has self-reported.

Prescribing Provider – The provider who prescribed the associated medication.

Filling Provider – The place of service in which the associated medication was dispensed.

Remote Patient Monitoring (RPM)

Results Table – For patients who are enrolled in RPM, the results from their associated devices will populate in the Results table. This table can be exported to a PDF and sorted based on the available headers.

Weight – Depending on the device used to monitor weight, the values may be normalized from metric to imperial. Once the data has been normalized from kilograms to pounds, the weight is then rounded to the nearest pound.

Resting Heart Rate – The value displayed is the raw data from the device used to monitor the patient’s heart rate when at rest.

Blood Pressure - The value displayed is the raw data from the device used to monitor the patient’s blood pressure. The values are listed as Systolic/Diastolic.

Trending Charts – Either the normalized values or raw values are plotted in a graph with the associated date of the reading to show the trend over time. The Y Axis is represented by the value associated to the device reading, while the X Axis represents the date of the reading.

Admit, Discharge, Transfer (ADT)

View Events tab includes admit, discharge or transfer (ADT) events. 

 

Social Determinants of Health (SDOH)

Under View Events tab you may view patient's responses to SDOH questionnaires.