Revenue reconciliation helps plans optimize revenue by highlighting and prioritizing discrepancies between plan data and CMS data including special statuses, demographic information, and risk scores.
The profitability of a Medicare Advantage plan depends not only on the effectiveness and efficiency of their enrollment and member management group to provide correct data to CMS, but also on the accurate recording of member premiums.
Reveleer's Revenue Reconciliation solution works directly with your enrollment solution or other core membership systems to quickly identify prospective payment and retrospective adjustment discrepancies and send them to your enrollment or member management group for resolution. Attesting to the accuracy of CMS payment reports (MMR) compared with a plan's internal records has never been simpler.
Our solution allows Health Plans to easily load membership, bid information, and MMR to quickly identify member, special status, and payment discrepancies.
Enrollment and Special Status discrepancies are captured where corrections can be made to either plan data or appeals to CMS.
Payment-level discrepancies are identified indicating issues with bid information or CMS payment processing errors.
Identify data and process issues early that will impact your payments from CMS by identifying and tracking member, special status and payment discrepancies between your MMR and internal data.
Reveleer’s Revenue Reconciliation module allows users the ability to view data at summary and detail levels to diagnose the reason why identified discrepancies exist and correct the problem.