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Complete and Compliant Encounter Data Submission
Synova ensures that your encounter data is accurately captured, processed, and submitted to the Centers for Medicare & Medicaid Services (CMS) in a timely and compliant manner.
helps with
- Accurate data submission
- CMS compliance
- Timely processing
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Coding Gap Analysis
Synova identifies discrepancies, errors, or gaps in coding practices that impact reimbursement, compliance, and revenue integrity. Our team reviews documentation practices, conducts coding audits, and utilizes coding validation tools.
helps with
- Identifying coding errors
- Enhancing compliance
- Improving revenue integrity
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Real-time Dashboards
Projection of Risk Adjustment Factor / Medicare Risk Adjustment. Synova uses real-time dashboards, which play a crucial role in data visualization and monitoring, risk adjustment score tracking, performance monitoring, and KPI tracking.
helps with
- Data visualization and monitoring
- Risk adjustment score tracking
- Performance and KPI tracking
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High Operational Cost
Managing large data volumes, concurrent users, and processing demands requires optimal performance and scalability of EDPS and RAPS systems. We achieve this through performance tuning, system upgrades, and database optimization. Additionally, we implement load balancing, caching mechanisms, and resource allocation strategies to enhance system scalability and responsiveness, ensuring smooth handling of high workloads.
Data Integration and Interoperability
Managing changes, system updates, and technology upgrades requires effective change management and user adoption strategies. We provide user training programs and clear communication to prepare teams for system changes, new features, and technology enhancements. Furthermore, we offer ongoing support, user feedback mechanisms, and user adoption initiatives to ensure smooth transitions and maximize user satisfaction.
Measurable Impact
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Prevent Revenue Leakage
Synova provides Medicare advantage health plans with solutions for submitting accurate encounter/RAPS data to CMS.
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Optimized RAPS
By optimizing your RAPS processes, you can ensure that your Medicare Advantage members' risk scores accurately reflect their health conditions and healthcare needs, ultimately leading to appropriate reimbursement and revenue optimization.
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Steady revenue generation
Synova’s solution will help the risk manager to identify and prioritize encounters by risk, reconcile discrepancies, and positively impact revenue.
Data Analytics and Actionable Insights
EDPS and RAPS provide valuable data analytics capabilities, real-time dashboards, and performance metrics for data-driven decision-making.
Data Collection and Extraction
The process begins with collecting and extracting relevant patient data from various sources, such as electronic health records (EHRs), practice management systems, and other health IT systems. This data includes patient demographics, diagnoses, procedures, and other clinical information required for EDPS and RAPS submissions.
Data Validation
The collected data is thoroughly validated to ensure accuracy and completeness for accurate risk adjustment and encounter data reporting.
EDPS and RAPS Submission
Once the data validated, we prepare and submit the EDPS and RAPS files to Medicare Advantage plans or Centers for Medicare & Medicaid Services (CMS).
Constant Monitoring, Reconciliation, and Reporting
After the EDPS and RAPS submissions, we monitor the processing and acceptance of the submitted data, reconcile any discrepancies or rejections and work on resolving any issues or errors identified by the receiving entities.
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The Encounter Data Processing System (EDPS) is a system used by the Centers for Medicare & Medicaid Services (CMS) to collect, process, and store encounter data from Medicare Advantage (MA) organizations. This data is used for risk adjustment and payment purposes.
EDPS and RAPS are critical for ensuring accurate risk adjustment payments. Accurate data submission affects the reimbursement that MA organizations receive from CMS, impacting their financial performance and ability to provide services.
The Risk Adjustment Processing System (RAPS) is a system that CMS uses to collect diagnosis data from Medicare Advantage organizations. This data is used to adjust payments based on the health status and demographic characteristics of enrolled beneficiaries.
Medicare Advantage organizations submit encounter data to CMS through the EDPS. This data includes details about the services provided to beneficiaries, such as procedure codes, diagnoses, and provider information.
EDPS collects comprehensive encounter data, including all services provided during a patient visit, while RAPS focuses specifically on diagnosis codes used for risk adjustment purposes.
Organizations submit diagnosis data through RAPS. These diagnoses are used by CMS to calculate risk scores, which adjust payments to reflect the health status of beneficiaries.
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Accelerated Outcomes
Value-driven Collaboration
Compliance Assurance
Bring a change to your Healthcare Operations
A partnership with Synova gives you an inherent:
Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.
Sense of ownership and commitment towards providing value.
Focus on speed, accuracy, efficiency, and optimal outcomes.
Sense of security and transparency through periodic reporting and actionable insights.
Connect with our experts for a quick analysis and possibilities.
