FCS Healthcare

FCS and Cavo Health – A Vastly Improved Approach to Risk Adjustment

FCS and Cavo Health

Forensics Consulting Solutions, (FCS) has partnered with Cavo Health to provide our healthcare and insurance clients with the most comprehensive approach to Risk Adjustment, Care Quality, and Compliance processes available.

Much of what Forensics Consulting Solutions (FCS) can provide in the Health Care vertical is very similar to our legal E-Discovery services.

FCS Services Risk Adjustment Mitigation:

  • Conduct Assessment of Client’s current systems and processes used to manage Risk Adjustment.
  • Make Technological and Process oriented recommendations to improve the Client’s Risk Adjustment, Care Quality and Compliance capabilities
  • FCS can design, manage and measure the results of the Proof of Concept or Pilot Project
  • Improve Business Processes (People, Process & Technology)
  • Development of Workflow, Process, and Procedures that work Synergistically with Clients current process or develop a new process
  • Implementation and Integration of Technological Solutions, such as Cavo Health, into the Clients existing organization and infrastructure.
  • Provide ongoing maintenance and support of Technological Solutions.
  • Improved Execution: Process data, build workflows, train supervisors and staff, or provide Project Management leadership initially or on an ongoing basis
  • Retrieval of Medical Records process
  • Optimization: Data integration process with Risk Adjustment technology &/or process
  • Analytical: Report, Monitor & Manage the Assisted Medical Coding process.
  • Assist with providing documentation and reporting services via EDGE Servers to Governmental Agencies (like CMS) as required for Risk Adjustment Compliance
  • Compliance: Support Internal Validation Audit process (16-week time limit)
  • Training, Assessment, Health Checks for Members, etc.

Cavo Health Services Risk Adjustment Mitigation:

Cavo Health is the complete medical record abstracting toolkit for Hospitals, Providers, Insurance Companies, and Academics. This powerful new tool, for retrospective, prospective, and auditing, has the versatility to deploy in the Cloud or behind your Firewall. With your data remaining safely behind your Firewall, you can unleash the powerful analytics and strategic, cross-stack reports of Cavo Health without worry.

Cavo Health focused its attention for semantic predictive coding on Latent Semantic Indexing (LSI), but have added some significant capabilities to what we are now calling Enhanced Latent Semantic Indexing (ELSI) (patent pending). We have added three customizable similarity measurements to the statistical model so that it more accurately and more quickly finds similar documents to a reference set. Traditional LSI uses the average cosine similarity between the query vector and the document vectors in the seed set. This approach has a serious drawback that it will give a lower score to a document that is highly similar to one of the seed document but dissimilar to most of the seed documents. Some applications may require ranking documents based on the similarity of their metadata in addition to the content-based similarities regardless of the reliability of the metadata in your particular data collection. Cavo Health enhances LSI to make it work in both of these cases. Cavo Health provides three different similarity metrics that contribute to the score of a document given an input seed document set.

  1. Average Seed Similarity: This is the average cosine similarity of the input document with all seed documents
  2. Best Seed Similarity: This is the similarity of the input document with the seed document closest to the given document in the reduced dimensional space. Put another way; this is the highest similarity of the document with any document in the seed set.
  3. Metadata Similarity: This is the average metadata similarity of the document with any document in the seed set. Metadata similarity is based on the following fields due to their high reliability:
    • Date
    • Date Falloff
    • Date within Days
    • Email Address
    • Title

With a team like FCS and Cavo Health at your side, your Risk Adjustment problems will diminish as your identification of HCC captures increases. That means a better bottom line for Healthcare Providers and Insurers while increasing the efficiency and level of care for your patients.