Case Study: California Medical Group achieves a $10M CMS reimbursement recovery with SCIO Health Analytics

Medical Group - Customer Case Study

California Medical Group, a medical group with about 3,000 Medicare Advantage members in California and contracts across multiple health plans, faced underreported risk-adjustment scores and an imminent 120‑day submission deadline. They struggled with disparate, inconsistent plan feedback and lacked physician access to what CMS had actually accepted, so they engaged SCIO Health Analytics (using its SCIORevMaxPro solution) to help reconcile diagnosis data and secure appropriate reimbursement.

SCIO Health Analytics deployed its web‑based SaaS, SCIORevMaxPro, to integrate plan and CMS data, display CMS‑accepted diagnoses, and give providers a single source of truth — implemented within 30 days. With unified visibility, physicians identified and resubmitted missing clinical information within 90 days, producing an additional $10 million in CMS reimbursement to the health plans, from which California Medical Group received a portion.