Data Security & Compliance: The Dwayne Johnson of Risk Adjustment

These days, Risk adjustment is a lot like WrestleMania these.  I am not sure if that makes CMS John Cena…but I am certain health plans should be prepared for that folding chair to the head move. 

Health plans need a new training regime and a new foundation. Security and compliance is the cornerstone on which a health plan’s risk adjustment strategies should be built, and it must be supported not only by all health plan departments, but also health plan vendors.

As stated in the CMS call letter, you need to know your business, which also applies to your vendor processes and procedures.  In a poll during our August 18 webinar, our audience of health plans shared that they only conduct onsite vendor audits twenty five percent of the time when they outsource risk adjustment servics.   Gorman Health Group can help you create the data security checklist, but health plans have to get in the routine of going onsite.  Get in the ring!

The health plan IT liaison needs to see the server room, understand the data back-up plan, notification process, and especially how the vendor handles data day-to-day. Is it sitting out on desks?  In employees’ car?  Scary things happen when you don’t ask questions. 

Even scarier was this poll result: only 55% of health plans read their vendor’s compliance plan.  You need to know not only what the vendor is doing on your behalf but also how.  With PHI fees and RADV extrapolation, make sure your vendor has a compliance plan and that you know what it says. 

Download a copy of last week’s webinar here.