You’ve Got Mail: National Sample RADV Audit Scores are In

April 23, 2015
|In Uncategorized, Risk Adjustment
|By GHG Advisors

By now you may have received your score from the Centers for Medicare & Medicaid Services (CMS) regarding the national sample for Risk Adjustment Data Validation (RADV) audits.

Wondering how you compare to your peers or competitors and what the implications of your score are?

Factors that should be taken into account regarding your score compared to the national average:

  • If you were to extend your score across your entire membership, would you be satisfied with the results?
  • What is the impact on your revenue and bid/benefit design?
  • Are inaccuracies going to have an impact on HEDIS measures and Medical Trend Management?
  • Do you have a long-term strategy to positively affect your results through concurrent reviews and targeted provider education/engagement strategies?

Regardless of what your results are, you need to have a solid action plan in place for improvement and maintenance. Due to the size of the sample, it is not statistically significant enough for your organization to receive the large scale impact this number potentially poses on revenue, medical costs related to beneficiaries, and your organization as a whole.

Mock RADV’s and concurrent chart reviews should be a part of your risk adjustment program, and should be coupled with targeted provider education and engagement strategies.

Critical next steps:

  • Implement standard operating procedures for internal Mock RADV audit programs
  • Leverage analytics to target and profile your provider network for education and engagement
  • Implement year-round concurrent reviews to ensure optimal results for revenue capture and avoidance of RADV exposure and potential overpayment recovery requests from CMS.

Gorman Health Group supports our clients in evaluating the efficiency, compliance, and strategic value of risk adjustment programs from start to finish. We have a unique opportunity to collaborate with our clients and design, implement and operationalize year-round processes to ensure risk score accuracy and alignment. Together, we can develop enterprise-wide strategies to manage medical costs and improve clinical quality outcomes.

If you have any questions or would like to hear more about how we can help, please contact me directly at dweinrieb@ghgadvisors.com.

 

Resources

Whether you rely on multiple vendors or a largely internal team, GHG can help you streamline the execution of your risk adjustment approach, and build a roadmap to ensure you’re keeping pace with CMS expectations in both compliance and health care outcomes. Visit our website to learn more >>

 

Gorman Health Group (GHG) announced its new vision for maximizing healthcare analytics and optimizing risk adjustment programs. Read the full press release >>