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On Point

MEDICAL REVIEW SUPPORT

Our experience in quantitative financial analysis entails: analysis of capitation rates for Medicaid, Medicare, and commercial programs; development of fee schedules; review of actuarial capitation calculations; and analysis of monthly claims data. We have developed, in conjunction with clinical staff, disease management protocols for Medicaid, Medicare, and commercial populations. Specific protocols were developed for substance abuse, cancer, heart conditions, and obstetrics. For the Office of the Chief of Staff, WRAMC, Destiny was tasked with compiling over 11,000 pages of patient complaints, synthesizing each complaint and summarizing into a predetermined database. This highly visible task was mandated by Congress and subject to Congressional Review in response to the Washington Post articles pertaining to WRAMC. Destiny quickly deployed twelve staff, including a Physician, to conduct medical review of the more complex complaints.

Tasks include process development, training, project management, data entry, data analysis, and conformance with HIPAA and confidentiality regulations for protection of sensitive data. Destiny also provided analysis of summary data by type of complaint, common complaint, source of complaint, in-patient vs. out-patient and volume.