Solutions For Fee-for-Service Revenue

Medicare FFS Compliance Program Initiatives

CMS has put in place several preventative services to help fund the move to value-based care. Lightbeam has developed a proven plan to operationalize each of these CMS programs to increase the number of patients involved within your organization.

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

There are several benefits to the AWV.

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

Lightbeam has many clients who have dedicated resources solely to focus on this initiative of driving more AWVs in their organization.

Benefits of AWV:

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

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 get the $42 PMPM during the program's existence. A huge benefit with CCM is that it enforces a proactive approach to managing patients who are chronically ill, which are the ones who tend to utilize more resources than those who are generally well. 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 and reduce the likelihood of an adverse event.

Benefits of CCM:

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

Lightbeam supports your goals of improving HCC coding accuracy to have an immediate impact on reimbursement. CMS determines health and 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 coding hierarchical condition category (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, so you do not have to. 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 could indicate a patient has an undiagnosed HCC condition. For example, if your patient is on a medication which 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

Visibility with Lightbeam

Lightbeam proactively finds patients who are eligible for these various programs, as well as those who are past due for a visit or checkup once enrolled. Lightbeam will automate the process of reaching out to the patient, encouraging them to schedule an appointment and get in the exam room, while notifying the provider of exactly what needs to be done to satisfy existing care gaps.