OperaCare, creators of software that automates and standardizes the Home Health Quality Assurance and Compliance process, launched a Value-Based Purchasing and Revenue Integrity Tool this week. Proactive management of Revenue Integrity, Cost of Care, and Patient Outcomes will soon define the difference between those Home Health agencies who receive VBP bonuses and those who receive penalties.
The Toolkit takes publicly reported data and, using OperaCare's proprietary algorithms, identifies:
The free Toolkit can be accessed at operacare.com/analysis.
"When it comes to the surviving VBP or any bundled payment group, how does an agency know what to improve if they don’t know their current standing?" said Michael McGowan, Founder and President of OperaCare. "This Toolkit will allow agencies to get an idea of how desirable they are as potential referral partners for Accountable Care Organizations, hospitals, and Alternative Payment Models."
He added that the tool also reveals revenue at risk for review, possibly leading to complex audit activities. "Both these metrics go hand in hand, and it is this information that most agencies don’t know about themselves. I do not want good agencies missing profitable opportunities just because they didn’t know what they didn’t know."
The Revenue Integrity Toolkit makes use of OperaCare's algorithms, applying historical data versus the pre-claim real-time data that OperaCare's clients enjoy. While extremely useful and telling, this information comprises only part of an agency's full story. The history of an agency's business is written in the data, and CMS depends on their surveyors understanding that history.
How OperaCare works
OperaCare consumes historical and live OASIS data to create a longitudinal illustration of an agency’s risk and outcomes, and a patient's probability of re-certification. This in turn generates a Cost of Care Per Episode report, comparing current costs to the amount potentially saved were OperaCare’s processes applied. Cost of Care is then ranked against other HHAs within a 25-mile radius, allowing an agency to identify competitors that may be more desirable as a partner to a hospital, physician clinic, or ACO. This is the same data CMS uses when identifying an agency for review. OperaCare's predictive models help the agency avoid said review.
OperaCare users can reduce the level of risk while increasing revenue using the same data points. Its live, software-assisted QA process enables OASIS documentation to be completed in the patient's home, reducing the workload for field nurses and QA staff. This leads to higher job satisfaction, reduced burnout, and ultimately increases clinician retention. This new approach to QA and Compliance provides a competitive edge and prepares agencies for the forthcoming changes in the industry, such as those coming from the IMPACT Act or Home Health VBP.
OperaCare automates and standardizes Home Health QA and Compliance. It reorganizes Quality Assurance and Compliance activities from a reactive, 1-2 day process to a live QA process, pre-alerts staff to toxic data patterns, and presents risk mitigation strategies that prevent transmission of audit-triggering data to CMS/MAC claims review auditors.
The software automates the Service Utilization Review, a standard operating procedure in hospitals and other primary care settings. It also standardizes OASIS Assessment documentation, a form of documentation that is notorious for subjectivity and open for what the CMS deem as fraud, waste and abuse. Led by an experienced State OASIS Coordinator, the company's mission is to protect HHA provider revenues, enhance business growth and increase financial stability.