INCREASE FEE-FOR-SERVICE REVENUE

Lightbeam’s population health solutions and value-based care services make finding opportunities to increase
fee-for-service revenue simple.

PROACTIVELY ENGAGE ELIGIBLE PATIENTS

With Lightbeam, you can proactively find patients who are eligible for a variety of fee-for-service programs, as well as those who are past due for visits if already enrolled. Lightbeam’s population health solutions can automate the process of reaching out to your patients, encouraging them to schedule an appointment and getting them into the exam room while notifying the provider of exactly what needs to be done to satisfy existing care gaps.

OPTIMIZE FFS OPPORTUNITIES WITHIN YOUR POPULATION

Payers and health plans have created several preventative services to help fund the move to value-based care. Lightbeam’s advisory services department has developed a proven plan so you can operationalize the FFS programs that make sense for your population, including the following:

  • Annual Wellness Visits
  • Chronic Care Management
  • Advanced Care Planning
  • Diabetic Screening
  • Flu Shot Administration
  • Many More

Annual Wellness Visits

There are several benefits to the AWV.

First, providers pay $172 in revenue for a first-time visit and then $111 for subsequent visits. Secondly, the AWV does not have to be conducted by a providera nurse can, allowing revenue to flow in without tying down the provider. The third benefit is that the AWV helps optimize quality measures; the way the visit is designed, providers can close up to 11 care gaps in one visit.

Lightbeam has many clients with dedicated resources that solely focus on this initiative to drive more AWVs in their organization.

Benefits of AWVs:

  • FFS Revenue
  • Close up to 11 Gaps           in a Single Visit
  • Retain Patient Attrition
  • Reduce PMPM Costs

CHRONIC CARE MANAGEMENT

Chronic care management (CCM) is another great example of a program we operationalize for our clients.

After identifying patients who are eligible for CCM services, care coordinators must spend at least 20 minutes of non-face-to-face time with the patient monthly to receive the $42 PMPM rate during the program’s existence. A huge benefit with CCM is that it enforces a proactive approach to managing patients who are chronically ill, as they are the ones who tend to utilize more resources. The more time care coordinators spend with them, the more likely they are to take their medications, eat nutritiously, exercise more, and ultimately improve their health to reduce the likelihood of an adverse event.

Benefits of CCM:

  • FFS Revenue
  • Monitoring Care Plan Compliance
  • Reduction in PMPM Costs

HCC CODING

Lightbeam supports your goals of improving hierarchical condition category (HCC) coding accuracy to have an immediate impact on reimbursement. CMS assigns risk to Medicare patients by looking at the risk adjustment factor (RAF) score. You can significantly impact reimbursement for your Medicare Advantage, MSSP ACO, and other contract populations by correctly recording HCC codes during a patient visit.

HCC codes must be recertified each year. Lightbeam’s HCC module does the work of scanning ICD codes from the previous year, and if a code is found that has not been recertified, you will receive a notification to quickly manage outdated codes.

If you provide data* from various sources, Lightbeam can identify trends that may indicate a patient has an undiagnosed HCC condition. For example, if your patient is on a medication that corresponds to a diagnosis but Lightbeam does not see that diagnosis on a claim, the patient may not be diagnosed. We call this a “suspect” code.

*Claims data is required to leverage the HCC coding module. Clinical data is not required but will enable suspect coding capabilities.

Real-time results from Lightbeam clients

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