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1 HCC REVENUE CYCLE management Reveal the Overlooked, Omitted and Obscure Capture Full Clinical Support for Requisite Revenue Mitigate Audit Risk

2 medicare advantage revenue cycle management Driver of Plan Success Your Medicare Advantage Risk Adjustment Factor determines your success. We ensure it s accurate, complete, and precise through sophisticated analytics, meticulous documentation of medical records, and advanced business process management. You can trust DST will generate equitable revenue reimbursement for the risk inherent in your Medicare Advantage population. You have dedicated valuable resources to the care and well-being of America s seniors. You ve carefully defined your medical policy, selected the best provider panel, and assured access to quality care. You ve defined outreach programs and hired exceptional clinicians to assist your Medicare Advantage members manage their wellness and their necessary care. You are committed to success. And yet, without exceptional Medicare Advantage revenue management, you may not have the revenue you need to keep these resources and programs available to your members. High risk patients consume more care resources and your plan must take appropriate, proactive steps to ensure you are receiving the proper reimbursement for the risk you have assumed and the care you provide. The CMS base rate does not always accurately reflect the actual burden of care required for the members of a specific plan, so it is imperative that your plan receives the correct revenue for the risk you have accepted. Uncompensated risk could easily undermine your plan. DST has managed many aspects of government sponsored health programs for decades, and is ISO 9001 certified. Because of this experience, our approach to HCC revenue cycle management ensures high accuracy, and reduces your risk. Simply put, DST s retrospective risk solution makes it possible to access vast, ever-increasing amounts of data in ways that ensure the efficient, accurate identification of members, rapid retrieval of medical records, conduct in-depth medical record analysis and coding, and maintain a realistic projection of expected returns from the risk adjustment process. DST s Revenue Cycle Management Process Superior Analytics Foundation of Medicare Advantage Revenue Cycle Management Physicians are busy providing care to a wide variety of patients and do not always focus on the documentation required for proper Medicare Advantage revenue management. Additionally, claims do not include vital clinical data to support Risk Adjustment Factors which leaves your plan uncompensated for the risk in your membership. To recover that lost revenue you need a superior analytics application. It must easily and seamlessly incorporate claims data with a full array of member, provider and clinical data, including ancillary and pharmacy. It must also overlay a highly advanced system of predictive analytics to quickly identify potential, uncompensated risk. DST s RiskAnalyzer is that application. RiskAnalyzer was created by a cadre of medical economists and clinical review experts as well as data management and process analysts to assure its ability to identify members, disease burden, and appropriate risk adjustment, as well as provide financial insight in an efficient manner. RiskAnalyzer generates a better suspect list because it does not rely solely upon on claims data; it routinely integrates and utilizes lab data, pharmacy claims, medication compliance, and other ancillary clinical data, allowing us to better identify those medical records most appropriate for review. Inherent in the solution is the predictive modeling power of The Johns Hopkins ACG System, which allows for additional identification of suspects for review.

3 riskanalyzer tm exceptional analytics RiskAnalyzer s powerful rules engines apply advanced search algorithms comprised of vast comparison and identification rule sets to the data, including: Diagnosis Persistency If a diagnosis for a chronic condition was present last year, it should be there this year as well Diagnosis Specificity One digit in a diagnosis code can make the difference between full payment or no payment Related Diagnoses Diagnosis codes that are used indicate the presence of additional conditions, that if captured would yield additional payment Pharmacy Utilization without Diagnoses Identifies the presence of certain conditions through pharmacy use, that are not otherwise coded Services with Implied Diagnoses The presence of a procedure indicates the presence of a condition that may not be coded Understated Risk ACG s can help determine patients where the CMS-HCC model is not adequately capturing patient risk These algorithms help to identify the right opportunities for retrospective risk adjustment and more equitable revenue. Additionally, our prospective review algorithms identify those members that should have prospective services performed, such as appointment scheduling or in-home assessment. You can alter the algorithms to create the balance to best support your population. DST estimates the probability of successful risk adjustment for each member identified on the suspect list. Using this probability adjusted capture rate, we work with you to determine: Prioritization of member and provider selection Revenue associated with the HCC adjustment Likelihood of achieving this revenue adjustment. Exceptional Record Retrieval and Abstraction Decisive Determinant of Success DST typically conducts more than 90% of medical record retrieval on-site, while others rely heavily on fax and mail-in retrieval. Being on-site assures better document quality and accuracy. It also allows for capture of sensitive data not always included in the primary medical record. DST medical record retrieval partners are highly adept at securing access to the provider s office, with minimal disruption and by scanning records on site dramatically reduce the potential for disclosing PHI inherent in copying, faxing and mailing patient medical records. Finally, whether the medical record is directly from an EHR, a scanned image or fax, DST routinely achieves the fastest cycle time from suspect identification to chart receipt. Once DST receives the secure, encrypted medical record, we utilize a highly efficient, proprietary Business Process Management platform to create workflows, queues, and rules to seamlessly automate and evaluate the medical record abstraction process. All current and prior HCC coding schemes from CMS and HHS are maintained in the HCC Coding System and the system is kept current with all CMS policy changes. The system intelligently matches diagnoses with HCC s to reduce human error. Tighter control over data management issues, use rules and probability based algorithms are in place to best identify potential abstraction errors for correction or secondary review. DST utilizes its clinical abstraction organization to abstract all diagnoses from the medical record, not just targeted diagnoses related to assumed HCC discrepancies. This ensures revenue process accuracy by: Reducing the tendency to simply accept, and possibly overstate, the targeted code Determining if target code yields higher incremental revenue Providing the ability to use additional clinical diagnoses to support health management initiatives. The results are reviewed by an internal QA team to validate and confirm adherence to audit policies. Our experienced coders are highly skilled, full-time, certified coding professionals trained in HCC coding paradigms to support payer revenue cycle management programs, including CMS HCC management for Medicare Advantage and HHS HCC management for the Health Insurance Marketplace. DST uses a unique training and quality assurance framework to deliver a combination of classroom and system based training programs to ensure strong initial training combined with ongoing coaching and performance evaluation. Unlike most vendors in the HCC space, DST employs coding associates on a year round basis rather than hiring seasonal labor. DST believes this policy results in greater accuracy, efficiency and consistency in the HCC abstraction process. It also improves job satisfaction and company loyalty. This means better results with less risk of audit for you and your Medicare Advantage plan. The DST HCC abstraction platform is designed to enhance coder efficiency. The screen is built with the navigational ease of a graphical user interface and the efficiency of a heads down data entry system. The platform is replete with data trapping and contextual data entry to reduce keystrokes and error. The system is able to code both ICD-9 and ICD-10 diagnosis codes and comes with date specific functionality to alert coders which diagnosis set should be employed.

4 rigorous data submission service Translating Results to Revenue About DST Health Solutions, LLC Medical record reviews and claims data are translated into the required format for submission to CMS via RAPS/ EDPS thereby closing the loop on the retrospective risk adjustment process. DST also provides error correction services for EDPS. DST Health Solutions, LLC, delivers contemporary healthcare technology and service solutions that enable clients to thrive in a complex, rapidly evolving market. Providing business solutions developed from a unique blend of industry experience, technological expertise, and service excellence, we assist our clients in improving efficiencies while also effectively managing the processes, information, and products that directly impact quality outcomes. Our portfolio of services and solutions, which includes enterprise payer platforms, population health management analytics, care management, and business process outsourcing solutions, are designed to assist clients in successfully managing their most important business functions while facilitating strategic and financial growth. We specifically support commercial, individual, and government-sponsored health plans, health insurance marketplaces, and healthcare providers in achieving the goal of affording the best possible care to their members each and every day. DST Health Solutions, LLC, is a wholly-owned subsidiary of DST Systems, Inc. For those plans participating in Health Insurance Marketplaces, DST provides an Edge Server Solution for CMS reinsurance and risk adjustment processing. Penetrating Reporting Insight Along the Way Every sweeps season, your retrospective risk adjustment initiative puts your revenue on the line. You can t afford to be in the dark when it comes to program management. DST HCC reporting suite provides complete transparency into the HCC process. It maintains the real-time status of each chart and its revenue impact in both nominal and probability adjusted dollars and provides alerts to any one in your plan that you desire. Drill-down capabilities allow you to see aggregated summaries appropriate for those in the executive suite, proving insight into individual members, providers, medical records, community or region. You can easily track the chart from suspect identification through retrieval, abstraction and submission. Aggregated information can be used to drive financial forecasting, underwriting and bid support for future CMS plan filings. Since RiskAnalyzer is fully integrated with the CareAnalyzer population health platform, which includes HEDIS, state-based quality reporting, and network management, it provides a true 360 o view of your members and providers. The integrated platform allows you to develop more effective health management programs to: Improve patient safety Reduce readmissions Monitor medication adherence Better engage provider networks through incentive based and shared savings programs. DST Medicare Advantage Revenue Cycle Management

5 DST Systems, Inc Corporate Drive Birmingham, AL dsthealthsolutions.com 2013 DST Systems, Inc. DST Systems, Inc. (DST) has provided the information in this Product Sheet for general informational purposes only, has a right to alter it at any time, and does not guarantee its timeliness, accuracy or completeness. All obligations of DST with respect to its systems and services are described solely in written agreements between DST and its customers. This document does not constitute any express or implied representation or warranty by DST, or any amendment, interpretation or other modification of any agreement between DST and any party. In no event shall DST or its suppliers be liable for any damages whatsoever including direct, indirect, incidental, consequential, loss of business profits or special damages, even if DST or its suppliers have been advised of the possibility of such damages.

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