Medicare, Medicaid &
Marketplace Data Analysis

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Visual Connections has experience with Medicare and Medicaid data, providing detailed analyses using a wide array of statistical techniques and identifying potential fraud, waste, and/or abuse. Our analysts are extracting insights from various CMS programs and projects and from healthcare data, and are measuring performance for Medicare, Medicaid, private plans, Medicare Advantage, the Medicare Prescription Drug program, Fee-For-Service (FFS) Operations, and for state-based programs.

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Our support in this service area includes reviewing and analyzing relevant statutes, regulations, and sub-regulatory guidance as well as researching, drafting papers and developing briefing materials, guidance, documents, and reports related to reviews and evaluations. Additionally, we develop, validate and manage data optimization and program integrity pilots that employ learning algorithms to make data-driven predictions and decisions.

 Medicare, Medicaid & Marketplace Policy Analysis

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Visual Connections offers expertise in reviewing and analyzing relevant statutes, regulations, and sub-regulatory guidance and technical support in researching, drafting papers and developing briefing materials, guidance, documents, and reports related to reviews and evaluations.  Our staff includes public health professionals who are highly skilled in program-related federal regulation and policy development, implementation and management—including Medicare Advantage (MA) Part C and Prescription Drug (PD) Part D payment policy design, and MA Part C risk adjustment data validation (RADV) activities utilization analysis, demographic profiling and analysis, operational oversight and compliance activities.

VC Subject Matter Experts (SMEs) have vast experience with CMS statutes, regulations, and guidance and have:

  • Provided inputs used in Federal Register Notices

  • Developed the methodology and performed modeling and analysis for the Improper Payments Act of 2002 (IPIA), Improper Payment Elimination and Recovery Act of 2010 (IPERA), and Improper Payment Elimination and Recovery Improvement Act of 2012 for Medicare Part C and Medicare Part D

  • Provided support on policy papers related to Medicare Part C and Part D on topics related to model calibration, extrapolation methodology, and improper payment methodology.

  • Supported the creation of papers for CMS to submit to the Department of Health and Human services summarizing analytic findings from analyses related to Medicare Part C and Part D

Medical Record Review

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Visual Connections offers medical record review and validation services and has extensive experience in this service area, having worked on various projects and ad hoc studies in the federal government space. The medical record review and validation processes involve medical record intake and evaluation of appeals submissions as well as operational, statistical, and business intelligence analysis. Medical record review can be highly labor-intensive and is predominantly manual in nature, requiring human reviewers to read through entire medical records associated with a given diagnosis submission. VC is working to change that practice and on a recent project we introduced Artificial Intelligence enabled tools to make this process more efficient through the incorporation of enhanced automation processes.   

 Coding

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Visual Connections’ offers medical coding services that involve reviewing and coding a sample of medical records from a variety of sources and performing qualitative analysis on them. This work also includes mapping diagnosis codes to Hierarchical Condition Categories (HCCs).

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Visual Connections employs best-in-class medical coders. Our coders receive extensive training and on-going education administered by certified trainers from both the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA). Many of our coders have educational backgrounds including science and medicine degrees. Our coders are certified with CPC, CPC-H, CCS and CCS-P coding degrees.