Patient Lookup Key Terms

Quick Profile

2019 vs 2018 HCC DX – Compares HCC scores in the current year to the previous year to aid in recoding efforts. HCC Scores are calculated from patient demographics and specific diagnoses to calculate a patient risk score. A larger score indicates the patient to be a higher level of risk than that of a patient with a lower risk score.

2019 vs 2018 Medications – Compares Medications billed in the current year to the previous year to aid in determining if diagnoses or medications are being billed for conditions that have not been billed or recaptured.

Current Diagnosis List (ICD-10) – The current years diagnosis codes as derived from the patient’s adjudicated claims.

Quality Care Gaps – If the patient is enrolled in a quality program, the list of measures will populate with an indication of what requires action, is not applicable, and what may be complete.

Cost and Utilization

2019 YTD Spend – The sum of paid claims in 2019.

2019 HCC Benchmark – A financial spend benchmark based on the patient’s HCC score.

2019 HCC Benchmark vs 2019 YTD Spend – Percentage of financial spend benchmark used year to date. What you spent vs what you have left.

Benchmark Prediction – A warning symbol to indicate if the Health Endeavors Algorithm predicts if the patient will exceed their benchmark before the end of the current year.

Out of Network Spend – The sum of paid claims for the current year billed by providers who are considered out of network per the configuration of your account.

Office Visits – A listing of dates in which the patient had an encounter that is considered an office visit.

Most Visited Provider – The name and NPI of the provider the patient is having encounters with most frequently.

Admits - Number of times in which the patient has been admitted during the current year.

Readmissions - Number of times in which the patient was discharged and within 30 days, readmitted to a hospital during the current year.

ED Visits – The number of times in which the patient has had an encounter considered to be an Emergency Department Visit during the current year.

ED Visits that led to Hospitalizations – The number of times in which the patient had an Emergency Department Visit and was admitted as a result of the ED Visit during the current year.

CT Scans – The number of CT Scans for the patient during the current year.

MRI Events – The number of MRI Events for the patient during the current year.

Patient Lookup

Dual Eligible – Indicates if the patient is dually eligible for Medicare and Medicaid benefits.

Medicare Status Code – Indicates how the beneficiary became eligible for Medicare benefits.

HCC Trend – The patient’s HCC score trended over a four-year period. HCC Scores are calculated from patient demographics and specific diagnoses to calculate a patient risk score. A larger score indicates the patient to be a higher level of risk than that of a patient with a lower risk score.

Claims History – A rolling 12-month period to provide an overview of the patient’s financial spend.

Part A Claims – The beneficiaries’ sum of claims in the rolling 12-month period that are billed by a facility or agency covered under Part A benefits.

Part B Claims - The beneficiaries’ sum of claims in the rolling 12-month period that are billed by providers for things such as outpatient care, preventative services, ambulance services, and laboratory services under Part B benefits.

Part B DME Claims - The beneficiaries’ sum of claims in the rolling 12-month period for durable medical equipment for things such as oxygen, canes, or infusion pumps that are billed under Part B DME benefits.

Patient Contact Details

Data Sharing – Details if the beneficiary has opted out of sharing their data and if claims data was ever received. This section will also detail the reason the beneficiary opted out such as the beneficiary was excluded by CMS or if the beneficiary is to decline.

Health History Form

Health History DX – A list of diagnoses codes found within the patient’s adjudicated claims data and has been supplied to the patient to denote which conditions the patient may not be aware of, managing, not managing, or feels that management is not required.

Diagnosing Provider – The provider who billed the first instance of the associated diagnosis code.

Health History Medications - A list of medications found within the patient’s adjudicated claims data and has been supplied to the patient to denote which medications the patient is taking, not taking, and has self-reported.

Prescribing Provider – The provider who prescribed the associated medication.

Filling Provider – The place of service in which the associated medication was dispensed.

RPM

Results Table – For patients who are enrolled in RPM, the results from their associated devices will populate in the Results table. This table can be exported to a PDF and sorted based on the available headers.

Weight – Depending on the device used to monitor weight, the values may be normalized from metric to imperial. Once the data has been normalized from kilograms to pounds, the weight is then rounded to the nearest pound.

Resting Heart Rate – The value displayed is the raw data from the device used to monitor the patient’s heart rate when at rest.

Blood Pressure - The value displayed is the raw data from the device used to monitor the patient’s blood pressure. The values are listed as Systolic/Diastolic.

Trending Charts – Either the normalized values or raw values are plotted in a graph with the associated date of the reading to show the trend over time. The Y Axis is represented by the value associated to the device reading, while the X Axis represents the date of the reading.