A new study from Beacon Healthcare Systems revealed that health plan clients using Beacon’s Virtual Appeals Manager (VAM) are seeing measurable performance improvement in their appeals and grievances star rating, sometimes jumping from 3.5 to a full 5.
As established by the Centers for Medicare & Medicaid Services, the Five-Star Quality Rating System provides an overall snapshot of a plan’s quality and performance and measures the experiences Medicare beneficiaries have with their plan as it relates to medical care, member experience and plan administration. Plans can earn a rating between 1 and 5 stars; those plans with higher ratings receive additional funding from CMS that they invest into better serving their members. VAM specifically helps plans to achieve high ratings on measures related to the fairness and timeliness of Part C and Part D appeal resolutions.
“The healthcare marketplace has been very welcoming to our Virtual Appeals Manager, and this latest report shows the dramatic impact this tool can have on a health plan’s performance and star rating as acknowledged by CMS,” said Beacon CEO Ken Stockman. “VAM supports all lines of business and is quickly becoming a must-have solution for health plans wanting to stay ahead of regulatory audit focus and improve their star performance.”
Beacon’s Virtual Appeals Manager is the healthcare industry’s most intuitive, easy-to-use appeals and grievances tool. Designed by health plan compliance and operational experts, VAM is a highly configurable and automated solution that can be implemented in record time and provides unparalleled control and transparency of cases from intake to review, thus ensuring complete compliance with CMS. VAM also helps reduce a massive amount of health plan letters into a manageable and efficient core of templates.
Among its unique features, Stockman says that Beacon’s product team can customize different aspects of VAM, pointing out that they built an advanced logic to support the appeal levels for a large Blues plan’s commercial line of business. Health plans themselves can also configure the system without IT involvement after initial implementation. And because Beacon’s secure cloud infrastructure is HIPAA compliant, it can ensure the highest information and data security to safeguard against data breaches and loss.
Virtual Appeals Manager is part of a suite of trusted solutions Beacon offers health plans, all designed to meet today’s regulatory requirements. Among its other key products is the Virtual Compliance Manager (VCM), the only solution in the industry to provide state-of-the-art compliance, analytics, monitoring, and regulatory guidance-tracking and routing capabilities. With separate modules for guidance, audit workflow and automated monitoring, VCM provides real-time auditing and monitoring of transactional data that allows a health plan the opportunity to correct and address issues immediately. Its Document Workspace Manager component helps plans distribute important information in a timely manner or assign group and individual tasks to ensure compliance and operational readiness.
“All of our products are designed to help our clients reduce costs, grow revenue and achieve their strategic goals,” said Stockman. “Beacon is committed to providing the greatest value to each client and to making sure that every experience a client has with Beacon is a great one.”
Beacon Healthcare Systems is home to the healthcare industry’s leading compliance and risk management technologies, providing health plans of all sizes and sponsorships with customizable and scalable SaaS (Service as a Software) solutions that ensure accountability, accuracy and operational efficiency. With a focus on appeals, grievances, compliance and analytics, Beacon HCS is the first place health plans turn to when they are looking for a trusted, experienced partner who can help them reduce costs, grow revenue and achieve their strategic goals. Founded in 2011, Beacon HCS is a privately held California-based company with a technology center located in Austin, Texas. beaconhcs.com