Medicare Advantage and PACE HCC Management you can trust

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About us


Who We Are

We are a group of dedicated and passionate people who make it our primary focus to help plans verify medical record documentation by member and create an audit trail to ensure that all CMS documentation requirements are met.

Additionally, DxID offers customized reporting by member, provider and plan, documentation to support earlier, more accurate interventions for members, as well as support for physicians in meeting their documentation requirements.

What We Do

DxID provides Medicare Advantage plans and PACE plans with enhanced expertise in HCC Management. At DxID, we help to ensure PACE participant and Medicare Advantage member profiles are complete, resulting in the most appropriate reimbursement from CMS.

  • Retrospective and prospective member chart reviews
  • Customized Health Risk Assessment creation and management
  • Financial reporting and forecasting, including bid rate support
  • Risk Adjustment Data Validation (RADV) consultation and support
  • RAPS and EDPS Submission file creation, testing and delivery
  • Customized provider education

Our Services


Revenue Management

DxID offers financial services that simplify the complexities of risk adjustment. Understanding your revenue flow and what affects your bottom line is key to the success of your organization. Our reporting capabilities combined with our understanding of the risk adjustment system can help your organization identify and improve areas of revenue shortage.

Risk Adjustment Payment Analysis

Analyze risk score trends to isolate areas that need improving.

Retrospective and prospective member chart reviews

DxID offers a chart review process which combs through medical records to ensure all diagnoses have been accounted for.

Customized Financial Reporting

Slice your reimbursement by plan benefit package, county, and disease state and use to gain invaluable insight into your member population.

Bid Rate Support

As the blended benchmark changes, bid rates will become increasingly complex. We help you understand, analyze, and plan for the bid process.

Data Management

Understanding where your data comes from and what it means is critical as the industry moves towards a data centric model. We know how doctors work. We know where there are gaps in the data as it is assumed to reflect care requirements and measurements. Our data management services will ensure you are getting the most accurate information possible. Where that data is insufficient, we will go out and get it.

Clinical and Population Reporting

Customized reports by beneficiary, provider, and disease state are priceless clinical tools. Using our proprietary DxAnalyzer, we help organizations track chronic diseases and develop plans for early intervention.

Health Risk Assessments

Knowing your beneficiaries is the key to providing quality care. We work with organizations to develop, implement, and retrieve health risk assessments that help organizations be confident they are doing all they can.

Processing of Claims to the Risk Adjustment Processing System

While the Centers for Medicare and Medicaid Services gear up for encounter data, it is crucial for plans to ensure their RAPS submissions are accurate. The DxID RAPS processing system ensures diagnoses are captured in accordance with CMS guidelines.

Encounter Data

The future of risk adjustment hinges on encounter data. We work with organizations to gather, format, prepare, test and submit encounter data in 5010 compliant formats, regardless of the present state. Ask us how we can help you with Encounter Data.

Risk Adjustment Data Validation Support

Our staff is experienced with national and targeted RADV audit management. Mitigate your risk of logistical error and let us support your RADV audit. We promise to collect every medical record and provide logical, supporting documentation for each and every valid submission.

DxCodeMapper


DxCodeMapper is a free application from DxID that allows you to browse, search,
and convert ICD-9 CM and ICD-10 CM diagnosis codes in accordance with CMS's established General Equivalence Mapping (GEM) methodology.

App Overview

  • Provides a topical browsing interface for all codes.
  • A flexible and fast user interface makes exploring diagnosis codes a breeze.
  • Unlike many other apps, allows bi-directional conversion between ICD-9 and ICD-10.
  • Enables powerful searching on codes and descriptions, even using partial words — if you type 'diab comp' when searching for diabetes with complications, you will get all of the possible options, in both diagnosis code sets, simultaneously.
  • Unlike many other apps, all descriptions are complete (using CMS official descriptions), and the app shows results sets that aren't truncated.
  • Provides a complete and accurate view of all GEM combination sets for each diagnosis mapping in a clear presentation style.
  • Includes both forward and reverse GEMs, providing the most complete view of applicable GEM mappings.
  • Diagnoses that are included in the CMS-HCC model are identified.
  • It is easy to modify your search even after you have drilled down deeply into the results; simply tap on the "Find" icon to go back to where you were.
  • Can be used online or offline.
DxCodeMapper

Video Overview (3:10)

App Download

Development Team

  • Michael Dorsett
  • Carrie Eberhardt
  • Brian Milne
  • Mila Newman

 

  • Shawn Porter
  • Brian Quigley
  • Glenn Smits
  • Brandon Strawser

Leadership


Each and every member of our staff understands health care.
We are experts in technology, medical coding, physician documentation, claims processing, and risk adjustment.

Betsy Gaffney

Founder / CEO

Betsy brings more than twenty years of experience on the technology and business side of health care, including product development, sales and marketing, strategic planning and development, and management. She possesses particular expertise in the field of electronic medical records and billing systems, and has held positions with health care providers and health care technology firms throughout the northeast.

Gino Startari

Controller

Gino is responsible for the financial accounting operations of DxID including financial reports and a comprehensive set of controls and budgets designed to mitigate risk, enhance the accuracy of the company's reported financial results, and ensure that reported results comply with generally accepted accounting principles.

John Haughton

Consulting Risk Adjustment Advisor

Dr. Haughton brings over twenty years of experience in health care research and clinical application of predictive modeling and risk adjustment to DxID as a physician and an engineer.

As Consulting Risk Adjustment Advisor, Dr. Haughton consults with DxID to support the interpretation of risk adjustment rules as they apply to Medicare Advantage and PACE formularies and technology tool development.

Brian Milne

Director of Technology

Brian brings two decades of experience to DxID with a keen sense for managing teams and systems that deliver value on time and under budget. He brings tremendous value to the leadership team at DxID which stems from a background in both software and hardware engineering and the risk adjustment industry.

Jennifer Doran

Director of Clinical
& Administrative Operations

Jenn brings more than a decade of experience to DxID. She oversees both the administrative operations staff as well as the clinical staff. These teams flex with the demands of our clients needs throughout the year and Jenn manages it all with a results driven approach.

What our clients say


Provider Office Feedback

DxID surveys each office by phone following the review
100% satisfaction rate
(96% of the offices called responded to the survey)

Our experience with DxID has been tremendously valuable already and we have only known them for about 8 months. We have already seen great benefits in terms of revenue as well as education. I have been consistently impressed with their professionalism, organization, security measures, and expertise. They are truly a partner in improving our PACE program.

All the reviewers have been "exceptionally professional, very unobtrusive, and have been doing exceptional work"

Great as you guys don’t make us print records and send them. You are one of the few companies that will travel to complete the review.

Let's Get In Touch!


Ready to start your next project with us? That's great! We hope to hear from you soon!

333 West Commercial St
Suite 3000
East Rochester, NY 14445

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855-855-DxID / 855-855-3943

Toll Free Fax: 844-248-3943