Last week at AHIP: How are you sleeping lately?

September 20, 2011
|In Risk Adjustment
|By GHG Advisors

We heard a lot about STARS and compliance, about integration and collaboration. But what should be keeping you up at night?  EDPS and RADV extrapolation.

Sean Creighton said that EDPS compliance and accuracy may affect your STARS rating and Jonathan Blum shared that the RADV extrapolation equation is under review but will be released soon.  EDPS compliance will be extremely important but won’t be a single source of information until 2013, due to the dual submission in 2012. RADV extrapolation is extremely impactful now today.

Are you confident about your program?
• Confident in your <20% HCCs submitted due to medical review chart?
• Confident in your <10% HCCs submitted due to member evaluations?
• Confident in your >70% HCCS submitted due to claims based HCC?

It is not just about revenue or suspect lists.  You have to have:
• compliance plan for risk adjustment
• chart and assessment warehouse
• an annual mock-RADV audit (for charts & member evaluations)
• reconciliation step for RAPS and EDPS
• claims submission scrub

Sleep well.