Medicare/Medicaid Risk Identification
OptumInsight can help you achieve accurate reimbursements from CMS and assist in enhancing patient outcomes through Medicare and Medicaid best practices for:
- Collecting Medicare claims and encounters data
- Processing and submission to CMS
- Identifying high-risk members with chronic conditions
- Providing interventions early to ensure quality clinical outcomes
- On-going assessment of member population
- Retrospective review and alternative submission practices, such as chart audits and hospital abstracts
- Prospective field outreach
- Financial review and reconciliation
- Web-based reporting and analytics that aggregates data across numerous sources to develop intelligent and actionable strategies
Consulting
OptumInsight medical management design, evaluation, and improvement consulting empowers you to evaluate population management programs, develop and implement pay-for-performance plans, and review disease and utilization management – all with an eye toward reducing costs and improving the health of your members.
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