Over the past four years, the CMS-HCC risk adjustment model has been on a slow, steady march to transition from using a blended model encompassing both the risk adjustment processing system (RAPS) and the encounter data processing system (EDPS) methodologies for payment calculation. However, as we covered previously, the transition is now heading towards its conclusion. For encounter dates in 2021 (PY 2022) and beyond, the V24 Medicare Advantage model will be used exclusively via EDPS for payment calculation.
We’re excited to announce that the Lumanent platform and Health Fidelity team is fully prepared to offer concurrent EDPS and RAPS support. 2021 encounter dates can be submitted via EDPS, but we will continue to support older MA models still using RAPS as necessary.
While CMS is supplying EDPS returns for payers and providers that go back as far as PY 2014, the submission model is not being retroactively applied to those years, which means where relevant, RAPS is still the default for submission on retrospective passes. For cases like these, and other programs (like internal audits), Health Fidelity’s solutions will also continue to support RAPS for relevant years and use-cases.
In summary: While CMS is cutting over its submission model, Health Fidelity is offering concurrent support of EDPS and RAPS. We can still make full use of RAPS data, we have simply readied our system for EDPS as well.
Equally exciting is the additional opportunity presented by EDPS. Lumanent solutions use our NLP and inference engines to process data from disparate sources and make coding suggestions or present suspected condition gaps. The greater the granularity of available data, the deeper that review can go, while also allowing for more sophisticated suppression. While EDPS is a payment methodology, it has a multifold increase in granularity. This means the continued evolution of Lumanent will offer even greater accuracy and an even higher level of fine tuning, increasing coder productivity and condition identification acuity, particularly for Lumanent Retrospective Review users.
Note that while provider organizations using concurrent coding workflows via Lumanent Post-Encounter Review have already transitioned to EDPS, this update and the CMS cutover does not directly impact 2020 coding operations for Retrospective Review partners.
Finally, if you are a current Health Fidelity partner, your account manager is fully prepared and ready to answer any questions you may have about your own readiness. If you are not currently a Health Fidelity partner and would like to take advantage of our readiness and expertise, contact us today.