CMS Reimbursement

Lattice Group has developed numerous applications for use in the health care sector. Of them, are tools used by Clinical Auditing teams for obtaining accurate Centers for Medicare & Medicaid Services (CMS) reimbursements. These tools work by first capturing member/patient diagnosis information by entering disease classification codes (ICD-9 codes) into the system.  The description, HCC, and RxHCC scores associated with the entered ICD-9 codes are then automatically populated. This information is in turn used by the Health Plan and Insurance companies for payment reimbursement through Medicaid/Medicare. For more information about risk adjustment approaches and CMS Reimbursement, please see Risk Adjustment.

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