The Clock is Ticking…

If you are a veteran of Medicare Risk Adjustment reporting, you are probably in high gear planning or implementing year end programs to optimize 2014 and 2015 revenue. But is the same old approach you used last year the right approach for this year? Or maybe you are new to Medicare Risk Adjustment or Commercial Risk Adjustment reporting and not quite sure of what programs you should be doing this time of year.

GHG has experienced Risk Adjustment analysts and consultants that can help you meet and exceed your yearend goals. Below is our checklist of processes you should be doing now to help ensure complete and accurate Risk Adjustment data reporting for yearend:

• Implement analytics that appropriately consider the new Medicare blended HCC model.
• Suspect targeting for Medicare and Commercial chart reviews — Employ a targeted approach to cast a wide net, but optimize program results.
• Suspect targeting for 2014 Medicare and Commercial member outreach — Member calls, in-home assessments, provider interventions — one approach alone won’t get you there.
• Chart review execution — Know what your vendors are coding (do they include Rx HCCs?). Could computer aided coding reduce costs and improve ROI? What is the quality of the vendor reviews…would they hold up in an audit? Are they also looking to delete codes?
• Commercial Risk Adjustment — Select an independent vendor to perform your required audits.
• Audit Readiness — Execute the appropriate data quality audits now to minimize audit risk next year.
• ICD — 10 — Revisit or develop an implementation plan…ready or not here it comes!

Plans need to be proactive in their data capture to submit data before the January 31, 2015 deadline for Medicare and April 30, 2015 deadline for Commercial. Data accuracy also needs to be a priority with both programs to minimize audit risk and government take-backs.

Our team of experts can show you the way. Please contact us today.

Resources

Gorman Health Group can help ensure that your procedures for capturing, processing and submitting risk adjustment data to CMS are accurate, timely, and complete. Visit our website to find out how GHG can help ensure you are ready for that RADV audit when CMS calls >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>

Join us on September 19 for an in-depth discussion on the end-to-end management of data from noting identified gaps in data processing, concerns regarding data completeness and accuracy.” Register today >>