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Risk Adjustment Data Validation Audits: Auditors Target Medicare Advantage Plans

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Through the use of extrapolation of 200 charts, your facility could be caught in a huge new recovery effort by CMS to crack down on inappropriate risk adjustment recoupment. The CMS goal: Return to the Medicare Trust Fund $1 billion by 2020.

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Product Code: AR012419


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Risk Adjustment Data Validation (RADV) audits are much like rattlesnakes startled from hibernation: angry and quick to attack with serious consequences. It's January and auditors are poised to strike. Expect increased contract level RADV audits of 200 charts with extrapolation of findings likely to be now underway for Medicare Advantage plans and participating networks. In fact, under pressure from U.S. senators, the Centers for Medicare & Medicaid Services (CMS) is redoubling its effort to rein in inappropriate risk adjustment recoupment. The CMS mission is to use RADV audits to return to the Medicare Trust Fund $1 billion in 2020. The bad news: Your facility would be caught in this massive national recovery.

So, ask yourself these reality-check questions: Are all of your risk adjusting submitted diagnoses supported by sufficient documentation in the medical record? Do you have an adequate general compliance approach?

Is your plan and provider network ready for contract level RADV? Can you demonstrate "sufficiency of documentation" to support your submitted risk-adjusting diagnoses? This webcast will help prepare you for contract level RADV audits, and help you develop and implement a compliance plan to ensure your organization is RADV ready.

Why This is Relevant:

Contract level RADV audits expose organizations to multi-million-dollar risks. A compliance plan for risk adjustment helps to mitigate those risks.

Learning Objectives:

From this exclusive RACmonitor webcast with Dr. Jonakin, you will…

  • Understand the concept of sufficiency of diagnosis;
  • Be able to prepare a compliance plan that demonstrates your organization's commitment to compliance integrity;
  • Learn the components and implementation of a general compliance plan;
  • Understand the components and implementation of a focused compliance plan; and
  • Come to understand the components and implementation of a "tail" compliance and repair plan.

Who Should Attend:

Medical Directors, Risk Adjustment Managers and Directors, Revenue Cycle Managers and Directors, Compliance Managers and Directors, Coders and Auditors