Advantmed’s New HITRUST CSF® Certification: Five Key Implications for Data Security and Privacy

As hospital systems and physician data shift from local infrastructure to the cloud, a provider’s ability to control and secure data has weakened.  This creates substantial challenges for hospitals that need to assess third-party vendors and ensure that data complies with HIPAA and other regulations.

As a result, a growing number of providers and vendors are adopting the Health Information Trust Alliance (HITRUST) Common Security Framework (CSF) to streamline the vetting process. HITRUST was born out of the belief that information security should be the core pillar of the broad adoption of health information systems and exchanges.

Value to All Organizations

HITRUST CSF® certification can be used by all organizations to guide them in selecting and implementing the appropriate controls to protect the systems that create, access, store or exchange personal health and financial information. This certification gives organizations detail and clarity related to information security controls tailored to the healthcare industry.

Certification advantages are twofold: First, it’s designed to examine regulations. During the certification process, an independent assessor uses the HITRUST framework and then submits work papers to HITRUST for scoring and quality assurance. This ensures providers a level of consistency from one assessment to another.

Second, HITRUST performs a gap analysis, which providers can request to help them further assess a vendor’s security posture, which saves substantial resources.

Five Benefits of Advantmed’s HITRUST CSF Certification

  1. Cross references the requirements from legislative, regulatory, HIPAA, NIST, ISO, state laws and others for one comprehensive framework
  2. Provides a framework that prepares organizations for new regulations and security risks once introduced
  3. Ensures compliance and security protection to clients
  4. Assures payers working with Advantmed that our ELEVATE! platform is compliant, private and secure and meets the necessary requirements of HITRUST CSF certification.
  5. Means a third-party assessed the platform and attests to its compliance with globally recognized standards, regulations and business requirements, ensuring data security, privacy and compliance for all our clients

ELEVATE! assists in optimizing risk adjustment and quality improvement by providing real-time project status updates and reporting for risk adjustment analytics, medical record retrieval, HEDIS® abstraction, risk adjustment coding, claims and data validation, prospective health assessments, and more.

To learn how Advantmed can improve your risk adjustment and quality programs, visit www.advantmed.com.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Advantmed’s ELEVATE! Software Receives HITRUST CSF Certification, Validates Commitment to Safeguarding Sensitive Information

Santa Ana, CA — August 29, 2018Advantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, received the HITRUST CSF Certification from HITRUST Alliance, a not-for-profit organization whose mission is to champion programs that safeguard sensitive information and manage information risk for organizations across all industries and throughout the third-party supply chain. Founded in 2007, HITRUST Alliance collaborates with privacy, information security and risk management leaders from both the public and private sectors to develop, maintain and provide broad access to its widely adopted common risk and compliance management and de-identification frameworks; related assessment and assurance methodologies; and initiatives advancing cyber sharing, analysis, and resilience.

“We are proud that our ELEVATE! solution has been certified by the HITRUST CSF, the most widely-adopted security framework in the U.S healthcare industry, which continues to improve and update its framework ensuring that organizations like Advantmed are prepared when new regulations and security risks are introduced,” says Amit Patel, vice president of technology and compliance, Advantmed.  “This important certification is further validation that Advantmed provides a certifiable framework that provides health plan organizations with a comprehensive, flexible and efficient approach to regulatory compliance and risk management,”

Leveraging nationally and internationally accepted standards including ISO, NIST, PCI, HIPAA, and state laws to ensure a comprehensive set of baseline security controls, HITRUST CSF normalizes these security requirements and provides clarity and consistency, reducing the burden of compliance.

“Advantmed partners with health plans to elevate revenue and quality improvement with services that offer optimal results,” says Patel.

Advantmed’s solution suite includes risk adjustment analytics and coding, medical record retrieval, claims and data validation, HEDIS measurement and reporting, medical record abstraction, prospective health assessments, physician record review, member engagement and provider education.

About Advantmed, LLC
Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs.  Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members.  For more information on Advantmed’s solutions visit www.advantmed.com.

About HITRUSTHITRUST actively participates in many efforts in government advocacy, community building, and cybersecurity education. For more information, visit www.hitrustalliance.net.

Advantmed Advances Payer Understanding and Preparation for 2019 Medicare Advantage and Part D Rate Announcement and Call Letter, Issues Fact Sheet

Santa Ana, CA — April 12, 2018 — Responding to the recent release of the 2019 Medicare Advantage and Part D Rate Announcement and Call LetterAdvantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, announces the release of its Fact Sheet, highlighting key points to help Medicare Advantage (MA) plans to understand the implications and prepare for these changes.

“MA plan capabilities related to reimbursement, medical cost management, and risk adjustment must be responsive to CMS changes,” says Jay Baker, senior vice president, quality and risk adjustment solutions. “Advantmed recognizes that this is not always a simple undertaking and will lend its expertise to MA plan leaders who can benefit from our experience.”

Highlights from the CMS Call Letter:

  • Finalizing the proposal to calculate risk scores by adding 25 percent of the risk score calculated using diagnoses from encounter data and FFS diagnoses with 75 percent of the risk score calculated with diagnoses from RAPS and FFS diagnoses.
  • Finalizing an updated HCC Risk Adjustment model that incorporates most of the proposed changes to the Part C risk adjustment model, such as adding mental health, substance use disorder, and chronic kidney disease conditions to the risk adjustment model, as well as a variety of additional technical updates.
  • +3.4 percent expected overall YOY change in revenue from Part C Methodology.
  • Expects the underlying coding trend to increase risk scores, on average, by 3.1 percent.
  • Plans to begin implementing the “Payment Condition Count Model” to account for members with multiple conditions in 2020.

“A process should be in place to gather and report encounter data, while quickly troubleshooting submission issues,” Baker adds. “Adjusting to these changes will require specialized expertise because adjustments will impact plan performance, patient care, and compliance. Successful health plans and provider-sponsored organizations must integrate risk-adjustment strategies to meet growing regulatory and market demand for care quality that leads to better patient outcomes.”

About Advantmed, LLC

Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs.  Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members.  For more information on Advantmed’s solutions visit www.advantmed.com.

Advantmed Physician Record Reviews: Medicare Advantage Plans Gain Clinical Insights for Risk-Adjusted Conditions and Quality/Care Management Opportunities, Impact HCC Coding & CMS Reimbursement

Santa Ana, CA — February 14, 2018 — Advantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, today introduces Physician Record Review (PRR), a two-stage retrospective chart review process, first by a certified coder and second with a board-certified physician. This empowers Medicare Advantage (MA) plans with clinical insight into risk adjusting conditions to enhance traditional analytical platforms.

“The ability of physicians to review progress notes for primary care, specialists’ hospital charts, radiology and laboratory results not routinely used in standard analytics provides for more demonstrable actionable information,” says Nilay Shah, president of Provider Solutions, Advantmed. “Additionally, PRR identifies care opportunities in accordance with evidence-based medicine. The Advantmed physician staffs are board-certified in their area of specialty with extensive risk-adjustment training to uncover the potential for risk-adjusting conditions not identified by current programs.”

Shah says that PRRs represent one of the best opportunities to focus on Hierarchical Condition Categories (HCCs), explaining, “Our team of physician reviewers identifies HCCs within each patient chart, annotates risk adjustable conditions by page number, and integrates these outputs into a broader array of activities.”

CMS uses HCCs to reimburse MA plans based upon the health of their members. It pays for the predicted cost expenditures of patients by adjusting those payments based on demographic information, Medicaid status and the severity of illness or patient health status as recorded in medical record documentation.

“Advantmed PRRs also confirm the previous two years of submitted HCCs for clinical confirmation not currently submitted in the calendar year,” says Shah. “The goal is to provide a complete picture for the risk adjustment factor, increasing the accuracy of the patient’s risk score and, ideally, creating clean claims and faster reimbursements.”

Advantmed received certification from The National Committee for Quality Assurance (NCQA) for 2018 HEDIS measures for the 12thconsecutive year. Read more here.

About Advantmed, LLC

Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs.  Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members.  For more information on Advantmed’s solutions visit www.advantmed.com.