Optimizing Reimbursement in
Value-Based Care

ValueCycle Health helps healthcare providers and payers maximize reimbursement under value-based Medicare Advantage (MA) contracts. Our SaaS platform ensures accurate accounting of patient risk and disease burden by minimizing diagnosis code leakage, which can cause 5% reimbursement loss. On average, ValueCycle recovers 96% of this leakage.

With increasing scrutiny from MedPac, OIG, and CMS on Health Risk Assessments, the v28 HCC model rollout, and other MA risk adjustment techniques, now is the time to minimize leakage and maximize risk-capture accuracy and reimbursement.

"Eliminate the typical value-based contract risk leakage of ~5%, which equates to $1,000,000 in lost revenue per year per 2,000 MA VBC lives."

Why Choose Us?

1

Maximize Risk-Based Revenue: Our advanced analytics, rules-engine, and tools help identify potential revenue losses, ensuring you receive full and appropriate compensation for the care you provide.

2

Minimize Leakage: Our platform diligently tracks and addresses gaps in claims processing, reducing the loss of diagnoses (ICD-10 codes) and thus Hierarchical Condition Category (HCC) codes that impact your risk-adjustment and reimbursement.

3

Enhance Efficiency: Streamline and automate your ICD/HCC leakage recovery process with our user-friendly software, allowing your team to focus on delivering high quality care.

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Overview

Revenue cycle management (RCM) for value-based care has multiple dimensions that traditional RCM systems fail to capture. Variation amongst payer contracts, elongated reimbursement timelines, and data complexities make it difficult to accurately submit, predict, and reconcile risk-adjusted reimbursements with care rendered.

The process of capturing revenue associated with the conversion of ICD-10 diagnoses codes to Hierarchial Condition Category(HCC) codes in particular is subject to discrepancies as diagnosis codes move from clinical documentation to billing, from billing to payers, through risk-adjustment testing, and from payers to CMS.

Reconciliation of coding across these stakeholders in an arduous process that is occasionally done manually(if at all) and fraught with error. It is estimated that providers lose upwards of 5% of risk-adjustable revenue in this process. This translates into substantial revenue left on the table - for an organization with 50,000 covered MA VBC lives, over $15-25M in revenue could be lost each year.

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