Introducing RAMP™ by FRG: Our newest revenue auditing and monitoring program for Medicare Advantage plans, risk-bearing provider group and chart audit companies participating in and serving value-based contracts.

We are thrilled to announce the re-launch of our latest reporting service, the Revenue Audit and Monitoring Program (RAMP™ by FRG), a quantitative and transparent approach to risk adjustment analysis designed to help a wide range of healthcare organizations participating in value-based deals.

Challenges with Risk Contracts

The obligation to document, recapture, and maintain accurate coding specificity to ensure proper risk adjustment of revenue under global capitation is a challenge well known among health plans who are experienced with risk-bearing contracts. There are various reasons risk-bearing Medicare Advantage Organizations (MAOs) struggle to achieve revenue goals, as they may not realize their revenue is at risk or by how much. MAOs may also be surprised financially by unfavorable restatement results or have difficulty engaging provider groups to drive results.

RAMP™ by FRG

Fortunately, FRG offers a recurrent revenue monitoring solution that addresses these specific challenges. FRG developed RAMP™ to help clients understand the foundations of risk adjustment, understand member-level analysis for each payment year they can affect and develop rational accrual-compatible bottom-up forecasts for revenue recapture efforts.

Key Features and Benefits

Appropriate revenue alignment drives sustainability. FRG starts with CMS sourced files, flags conditions considered chronic and looks for their recapture. We ignore suspecting from pharmacy sources and focus on the most conservative approach to estimating recoverable revenue. Then we show our work! Member by member, and by payment year by diagnosis and HCC, showing the impact of hierarchies. And we refresh it every month showing the benefit of natural recapture progress and re-estimating the recapture opportunity. We model Medicare Advantage via the CMS model and Exchange populations and Medicaid with the HHS model en mass via our service or one at a time via our MRA Calculator website.

No Margin, No Mission

FRG believes that health plans and physician groups managing risk for Medicare Advantage, Medicaid Managed Care, and Exchange populations need appropriate risk adjusted revenue to sustain all the expected costs of care. These are the facts:

expected costs of care

With RAMP™ by FRG, particularly in concert with FRG’s AccuReports® Cost Containment and Profitability module, teams have the ability to prioritize misaligned panels, strategically target investment in balanced coding audits, build accurate accruals, and set revenue budgets with confidence at the member level to achieve shared savings, surplus and margin creation goals.

 

Unlock New Opportunities with RAMP™

FRG’s RAMP™ solution is intentionally quantitative and comprehensive. View transaction-level detail by payment year for each member and see recapture opportunity rolled up by panel and across the organization. Plans and providers can process entire markets of managed membership to understand misaligned practices, inattentive providers and new enrollees.

Not sure where to begin? Consider these options:

  • Snapshot – one time report from historical CMS files highlighting opportunity at the organizational level and by provider with member level detail.
  • Deep Dive – one-time prioritized audit of a significant number of charts chosen based on a Snapshot; includes encounter-to-impact process review to identify breakpoints in the risk adjustment coding, submission and capture cycle.
  • Passive Monitoring – monthly Snapshots with data archival and reporting showing natural and initiative-driven progress through the annual risk adjustment period.
  • Active Monitoring – Passive Monitoring accompanied by regular prioritized chart audits to ensure gains of any Deep-Dive are maintained.

Need an Audit? Contact FRG!

We’re excited to share the potential of RAMP™ to help risk-bearing health organizations, and we hope you are too! For more information about RAMP™ and pricing, contact FRG via email at info@frgsystems.com or call 888-466-1025 today.