Payers send gap reports. Practices receive them, glance at a spreadsheet with hundreds of rows, and put it aside. By the time the year ends, the incentive is missed and the quality scores that affect contracts are lower than they should be.
Revelrex turns the gap report into a working list: who needs what, who is contacting them, what was documented and what is still open. Your clinical team does the care; we make sure it is organized, documented and counted.
Practices that benefit
- Primary care and internal medicine practices in value-based or quality incentive programs.
- Practices receiving gap reports from Medicare Advantage or commercial plans.
- PCMH practices that need population outreach evidence.
- Groups without a care coordinator to own the list.
What usually goes wrong
Gap reports that nobody owns
The report arrives, gets forwarded, and no one is responsible for working it.
Care delivered but not counted
A screening was done at another facility, or documented in a note the payer cannot see. The gap stays open.
Outreach without a workflow
Staff call patients between other tasks. There is no record of who was reached, who declined, or who needs a second attempt.
Year-end surprises
Progress is unknown until the payer's final report, when it is too late to act.
The actual work
Gap identification and organization
We consolidate payer gap reports and EMR data into one list by patient, measure and due date, and remove gaps already closed in your records.
Practice coordination
We agree who does what: which gaps are handled at the next visit, which need outreach, which need records from outside providers.
Outreach and workflow support
Call and message scripts, outreach tracking and scheduling support as defined in the engagement.
Documentation tracking
We check that completed activities are documented in a way the payer will accept (correct code, date, result) and chase supplemental data submissions where required.
Completion monitoring
Weekly progress by measure. Patients who could not be reached are cycled back with the next attempt date.
Reporting
Monthly gap closure report and a year-end summary for the practice and, where useful, the payer.
What is included
- Gap list build and maintenance for the measures and payers in scope.
- Outreach tracking and documentation checks.
- Monthly and year-end reporting.
- Coordination with Revelrex coding or billing teams where the practice uses those services.
Not included
- Clinical care and clinical decisions.
- Patient incentives or mailing costs.
- Direct data submission to payer portals unless included in the agreement.
- Clinical services, patient incentive costs, and payer program fees are not included. Outreach volumes beyond the scope in the agreement are quoted separately.
What your practice needs to provide
- Payer gap reports and access to quality dashboards.
- EMR access for documentation review.
- A clinical lead and a front-desk lead for the program.
- Agreement on outreach methods the practice is comfortable with.
Step by step
- 1
Baseline
Consolidate gap reports, reconcile against the EMR, and produce the open-gap list.
- 2
Plan
Assign gaps to visit-based closure, outreach or records retrieval.
- 3
Work the list
Outreach and documentation tracked weekly; visits flagged for the care team.
- 4
Verify
Completed activities checked for payer-acceptable documentation.
- 5
Report
Monthly progress report; year-end summary.
What you receive
Working gap list with owners and status.
Outreach log with contact attempts and outcomes.
Monthly closure report by measure and payer.
Year-end summary for the engagement year.
Add Gaps in Care to your Service Cart
A written proposal follows within two business days.
Frequently asked
Which measures can you support?
Common preventive and chronic-care measures: cancer screenings, diabetes care, blood pressure control, immunizations, annual wellness visits and similar measures that appear in payer gap reports. The scope lists the measures for your engagement.
Do you contact patients directly?
Only as defined in the engagement and under your practice's name and policies. Many practices prefer Revelrex to organize the list and scripts while their own staff make the calls.
Does this guarantee incentive payments?
No. Incentives depend on payer rules and patient participation. We make sure the work is organized, documented and reported so the practice gets credit for what it does.
Can this run alongside PCMH transformation?
Yes. Gap closure evidence supports several PCMH competencies, and the two engagements share the same practice contacts.