DataRap® is a proprietary, registered system for accurate coding and medical record documentation, which are the keys to success for providers and patients. This uniquely designed method and system could be implemented in any healthcare environment that utilizes risk adjustment and assessment as well as fee-for-service to the extent that the models are contingent on maintaining and monitoring patients’ health status data and using coding systems.

DataRap® is a system and method to review and monitor patient health-related data, capture all information necessary to describe a patient’s health status, maintain and update such information, and report or otherwise produce such information for appropriate purposes. DataRap® reviews assist in proper coding of diagnoses and complete and accurate documentation for patients enrolled in Medicare Advantage Plans through HCC assignment resulting in accurate payment.

The HCC model developed by the Center of Medicare and Medicaid Services (CMS) for Medicare Health Advantage Plans requires appropriate coding to identify the acuity level or actual health risk of the patient. Excellent documentation is essential to providing complete reporting and coding.

CMS is now basing health plan payments for Medicare Advantage patients on health status. Each year a patient’s medical record documentation must convey all evaluated chronic diagnoses in order for the patient to receive appropriate healthcare services in the upcoming year. The ICD-9 coding must be accurate and to the highest level of specificity. Documentation must portray the assessment and plan components.

DataRap® is designed to provide the following risk adjustment services:

• A method to monitor patients’ medical records through reviews of health-related data from all available sources by professional nursing and coding staff.
• Adherence to coding standards and CMS requirements.
• Validation reviews to monitor and confirm appropriate documentation and coding of the patient’s health status.
• Analysis and reporting of health-related data to identify health risks, trends, opportunities for improvement, and further research.
• Education of providers regarding the HCC model, coding rules, and documentation of the assessment and treatment plan for each patient encounter.

With DataRap®, our goal is to “Promote and Encourage Excellent Care for the Chronically Ill and Disabled.”

For more information on DataRap® and our Risk Management Assessment Services, please contact Richard Manning, SVP of Strategic Projects at
rmanning@wellmed.net or 210.617.4016