Post-service
>
EDPS and RAPS

Increased data accuracy. Reduced denials.

Our EDPS/RAPS solution for health plans ensures compliance with CMS and improves insight and decision making, strengthening their financial performance

100
k
cases processed
99
%
accuracy
100
k
cases processed
99
%
accuracy
100
k
cases processed
99
%
accuracy
100
k
cases processed
99
%
accuracy
What we offer

EDPS and RAPS

Medicare Advantage plans leverage EDPS and RAPS for accurate risk adjustment. EDPS, a secure system, facilitates encounter data submission with edits for accuracy and consistency. RAPS focuses on risk assessment using diagnosis data, allowing CMS to determine plan payments based on beneficiary needs.

Complete and Compliant Encounter Data Submission

Synova ensures that your encounter data is accurately captured, processed, and submitted to the Centers for Medicare & Medicaid Services (CMS) in a timely and compliant manner.

helps with

  • Accurate data submission
  • CMS compliance
  • Timely processing

Coding Gap Analysis

Synova identifies discrepancies, errors, or gaps in coding practices that impact reimbursement, compliance, and revenue integrity. Our team reviews documentation practices, conducts coding audits, and utilizes coding validation tools.

helps with

  • Identifying coding errors
  • Enhancing compliance
  • Improving revenue integrity

Real-time Dashboards

Projection of Risk Adjustment Factor / Medicare Risk Adjustment. Synova uses real-time dashboards, which play a crucial role in data visualization and monitoring, risk adjustment score tracking, performance monitoring, and KPI tracking.

helps with

  • Data visualization and monitoring
  • Risk adjustment score tracking
  • Performance and KPI tracking

Find what’s Right for you

Discover how Synova can unlock value through our customized solutions across all stages of your healthcare journey. From optimizing operations to enhancing patient care, we're here to support your journey toward excellence in healthcare delivery.

Challenges We Solve

Choosing EDPS and RAPS

High Operational Cost

Managing large data volumes, concurrent users, and processing demands requires optimal performance and scalability of EDPS and RAPS systems. We achieve this through performance tuning, system upgrades, and database optimization. Additionally, we implement load balancing, caching mechanisms, and resource allocation strategies to enhance system scalability and responsiveness, ensuring smooth handling of high workloads.

Data Integration and Interoperability

Managing changes, system updates, and technology upgrades requires effective change management and user adoption strategies. We provide user training programs and clear communication to prepare teams for system changes, new features, and technology enhancements. Furthermore, we offer ongoing support, user feedback mechanisms, and user adoption initiatives to ensure smooth transitions and maximize user satisfaction.

Measurable Impact

100
k
cases processed
99
%
accuracy
Customized Solutions

Designed for your Requirements

Our service solutions streamline operations, enhance patient engagement, and integrate advanced clinical support technologies, tailored to meet your specific needs with efficiency and excellence.

Prevent Revenue Leakage

Synova provides Medicare advantage health plans with solutions for submitting accurate encounter/RAPS data to CMS.

Optimized RAPS

By optimizing your RAPS processes, you can ensure that your Medicare Advantage members' risk scores accurately reflect their health conditions and healthcare needs, ultimately leading to appropriate reimbursement and revenue optimization.

Steady revenue generation

Synova’s solution will help the risk manager to identify and prioritize encounters by risk, reconcile discrepancies, and positively impact revenue.

Data Analytics and Actionable Insights

EDPS and RAPS provide valuable data analytics capabilities, real-time dashboards, and performance metrics for data-driven decision-making.

how it works

How Synova Is Integrated with your Business

Synova integrates seamlessly into business operations by deploying advanced technologies and specialized expertise in healthcare operations management. This integration optimizes processes, enhances efficiency, and ensures compliance, supporting sustainable growth and improved patient care outcomes.

01

Data Collection and Extraction

The process begins with collecting and extracting relevant patient data from various sources, such as electronic health records (EHRs), practice management systems, and other health IT systems. This data includes patient demographics, diagnoses, procedures, and other clinical information required for EDPS and RAPS submissions.

02

Data Validation

The collected data is thoroughly validated to ensure accuracy and completeness for accurate risk adjustment and encounter data reporting.

03

EDPS and RAPS Submission

Once the data validated, we prepare and submit the EDPS and RAPS files to Medicare Advantage plans or Centers for Medicare & Medicaid Services (CMS).

04

Constant Monitoring, Reconciliation, and Reporting

After the EDPS and RAPS submissions, we monitor the processing and acceptance of the submitted data, reconcile any discrepancies or rejections and work on resolving any issues or errors identified by the receiving entities.

frequently asked questions

All your Doubts Resolved

What is EDPS?

The Encounter Data Processing System (EDPS) is a system used by the Centers for Medicare & Medicaid Services (CMS) to collect, process, and store encounter data from Medicare Advantage (MA) organizations. This data is used for risk adjustment and payment purposes.

Why are EDPS and RAPS important for Medicare Advantage organizations?

EDPS and RAPS are critical for ensuring accurate risk adjustment payments. Accurate data submission affects the reimbursement that MA organizations receive from CMS, impacting their financial performance and ability to provide services.

What is RAPS?

The Risk Adjustment Processing System (RAPS) is a system that CMS uses to collect diagnosis data from Medicare Advantage organizations. This data is used to adjust payments based on the health status and demographic characteristics of enrolled beneficiaries.

How does data submission to EDPS work?

Medicare Advantage organizations submit encounter data to CMS through the EDPS. This data includes details about the services provided to beneficiaries, such as procedure codes, diagnoses, and provider information.

What is the main difference between EDPS and RAPS?

EDPS collects comprehensive encounter data, including all services provided during a patient visit, while RAPS focuses specifically on diagnosis codes used for risk adjustment purposes.

How does data submission to RAPS work?

Organizations submit diagnosis data through RAPS. These diagnoses are used by CMS to calculate risk scores, which adjust payments to reflect the health status of beneficiaries.

Your Process, Our Technology

Building a Partnership grounded in trust and transparency.

When we build solutions with healthcare organizations like yours, it significantly reduces development and adoption times. We work as partners to solve problems and unlock tangible value.

Accelerated Outcomes
Partnering with Synova reduces development and adoption times, expediting the delivery of efficient revenue cycle solutions.
Value-driven Collaboration
By combining healthcare organizations’ patient-focused experience with Synova’s expertise, our partnership unlocks tangible value and fosters innovation.
Compliance Assurance
Collaborating with Synova ensures solutions are developed to meet industry standards and regulations, fostering trust and delivering high-quality, compliant outcomes.

Bring a change to your Healthcare Operations

A partnership with Synova gives you an inherent:

Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.

Sense of ownership and commitment towards providing value.

Focus on speed, accuracy, efficiency, and optimal outcomes.

Sense of security and transparency through periodic reporting and actionable insights.

Connect with our experts for a quick analysis and possibilities.

Download Deck