Webinar on Risk Adjustment and RADV Audits

A sneak peak of what’s in the presentation:

Ø  Information on CMS’s Hierarchical Condition Categories

Ø  HCC payment methodologies

Ø  Documentation best practices

Ø  Top 10 RADV red flags

Ø  RADV medical record checklist

Ø  Practice reminders

Ø  Top 10 documentation issues

All-you-need-to know information on Risk Adjustment and RADV Audits

•      This presentation contains information on RADV Audits, which pertain to Risk Adjustment and how Providers and Coding Professionals, must understand, that they too, can be on the hook in the event a Medicare Advantage Plan is audited and found to have deficiencies.

•      CMS performs Risk Adjustment Data Validation (RADV) audits by reviewing provider medical record documentation to validate submitted diagnoses codes, as they correlate to HCC codes. Risk Adjustment Factor Scoring or (RAF), when properly reported, allows CMS to provide additional reimbursement to Medicare Advantage Plans, based on a Members’ overall health. The RAF scores are derived from the submitted diagnoses from what should be in the medical record. Higher weighted RAFs, correlate to sicker patients, which means a higher cost to the MA Plan to treat these sicker patients, hence, requires higher reimbursement to the MA Plans.

•      The main avenue in which Risk Adjustment Fraud and Abuse occurs, is by reporting chronic conditions and subsequent treatment, on patients that did not have the reported conditions or care, or upcoding on existing conditions, to make it seem more severe in nature than it is.

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