Timely and accurate reconciliation of Medicare enrollment and payments helps health plans to avoid revenue loss and unnecessary penalties. Large volume of CMS data and frequent revisions to payment methodologies and regulations often makes the reconciliation process complex. Some plans tend to lose up to 10% of their monthly capitation payments from CMS due to incorrect or incomplete information, apart from facing challenges in complying 45 days attestation timeline.
Wipro’s Revenue360 solution for medicare advantage plans adds intelligence and automation to the reconciliation process. It captures various Part C and/or Part D payments, including member premium for SSA withholding, automatically applies lump sum retroactive payments split across months, calculate plan expected payments for the month and reconcile the data every month. Payment reconciliation helps finance department in getting an accurate picture of money owed to CMS or potentially from CMS to the finance department.
Revenue360 web portal provides a simple and intuitive navigation to research and analyze discrepancies, keep a close track of open discrepancies to be worked upon and maintain an audit trail of actions taken to resolve discrepancies.
Each month Revenue360 automatically generates over 40 standard reports and data extracts to help Plans monitor trends and understand discrepancies, including reports on a payment summary, balance brought forward, discrepancy aging, suspense amount, and Prescription Drug Event (PDE) activity.
Apart from standard reports and extracts, the Revenue360 solution provides an add-on recon analytics, powered by a BI tool for data visualization and ad-hoc analysis and reporting by the end users.
- Intake CMS files, Plan membership data & Bids
- Capture Part C/D payments, including member premium for SSA withholding
- Track/apply retroactive enrollment/dis-enrollment adjustments and lump-sum payments split across months
- Online Dashboards track payments and discrepancies at the Plan and Member level
- 25+ and 55+ discrepancies, with payment impact
- Identify and track financial differences through resolution
- 40+ Reports and Extracts, including payment summary, balance brought forward,
aging, LICS and reinsurance balance, and suspense tracking
- Part D annual reconciliation and forecasting
- Provide accurate picture of money owed to CMS or from CMS