As 2011 comes to a close it is useful to reflect on how far we have come in a year. It is also relevant to project what 2012 has in store and what QMS is doing to ensure that our clients are ready to address these new challenges.
A year ago – year’s end 2010 – we were generating claims under the old “composite rate – case mix” rules with complex reporting of ESAs (EE, ED, and GS modifiers) but getting ready for a whole new paradigm, particularly for those that chose to go with 100% bundling. During the first quarter of 2011, modified claims were generated – expanded by the need to include labs and complicated by the need for timely electronic population of the claim file from lab contractors. With a few hiccups and some claim submission delays, QMS clients were able to generate a reliable revenue stream. Clinical practice quickly responded to the need to optimize clinical management (such as judicious use of ESAs) and tools available in QCS facilitated this optimization. Capture of co-morbidities was also critical using QCS. Also, Accounts Receivable tracking needed to account for the revenue “tail” associated with acute co-morbidities. As 2011 comes to a close the revenue and optimization aspects of client businesses seem to be stabilizing and are producing better results than were expected a year ago.