FINANCIAL ANALYSIS

FEATURES

Reporting: bookkeeping services, capitation payment and reconciliation management, financial reporting to health plans and federal or state regulators, IBNR estimates (tracking and reporting), encounter submissions

Strategy: financial & investment analysis services, operational/capital budget preparation, profit and loss analysis with recommendation for turnaround or improvement, pay for performance, risk-adjustment provider education and coding (Medicare and Medi-cal)

MSO helped start an IPA in 2015. This IPA started from zero Medicare Advantage part D (MAPD) members to approximately 3,200 MAPD members in the third quarter of 2018, with enrollment projected to exceed 4,500 members in 2019.  In 2018, the this IPA has a projected revenue of $25 million and $3.2 million in net income.

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The main factors which contributed to this great performance are the following:

  1. Improvement of revenue by almost double with increase of  average risk adjustment scores from 0.6 to 1.1 (with consistent diligent education of providers on proper coding of diagnoses)

  2. Monthly analysis of revenues from the health plan to ensure accurate capitation and claims payment. 

  3. Quarterly profit and loss analysis to identify specialties with high utilization and recommend closer review by the IPA Medical Directors

  4. Intensive case management of members with chronic health issues and high inpatient and outpatient utilization.