Regional Health Plan Boosts Risk Accuracy and ROI Through Targeted Retrospective Chart Review A regional payer operating across multiple states wanted to close a long-standing gap in risk score accuracy across its Medicare Advantage and ACA lines of business. Despite conducting routine retrospective chart reviews and following
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The Risk Adjustment Data Validation (RADV) rule was finalized by CMS in January 2023 to tighten oversight of Medicare Advantage (MA) plans. A central change was the removal of the fee-for-service (FFS) adjuster, which historically helped normalize error rates seen in MA and with those seen inRead More →
CMS is launching the most extensive RADV audit expansion in Medicare Advantage history. Health plans need to move quickly—and smartly—to reduce risk and limit exposure. One of the most common (and costly) mistakes? Contracting with the same vendors used for retrospective coding. Coders trained for retro reviews may bring
Read More →RADAR on Medicare Advantage, June 5, 2025 Following up on promises to root out fraud, waste and abuse in government-sponsored programs, CMS on May 21 stunned the industry with a bold plan to rapidly expand risk adjustment data validation audits (RADV) used to collect overpayments from Medicare
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Health Plan Weekly, May 30, 2025 Amid a flurry of CMS announcements about health care price transparency and Medicaid issues, the agency on May 21 unveiled a bold plan to collect Medicare Advantage overpayments through the expansion of Risk Adjustment Data Validation (RADV) audits. Industry analysts say the news
Read More →ATTAC’s HHS-RADV Audit Expertise Delivered for Our Clients in 2024 ✨ Overall Validation Rate: 94.2% 🚫 Overall Non-Validation Rate: 5.8% 🔍 Our Enhanced Audit Efficiencies Include: 📌 >99% claims matching rate 📌 Experienced in-house, on-shore ACA coding team 📌 Dedicated and experienced audit managers 📌 Web-based reporting
Read More →![[Webinar Replay] Essential Risk Adjustment Insights for 2025-2026: How Plans and Providers Can Stay Ahead of Regulatory Changes and Compliance Challenges](https://www.attacconsulting.com/wp-content/uploads/2024/03/Webinar-300dpi-570x172_c.jpg)
Watch The Essential Risk Adjustment Insights Webinar ATTAC Consulting Group’s risk adjustment experts presented an insightful webinar on risk adjustment planning for 2025 and 2026. We discussed a recommended risk adjustment calendar for both years, summarized best practices for health plans and providers, and outlined changes in
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December 5, 2024 issue of RADAR on Medicare Advantage Acknowledging the growing prevalence of obesity in the U.S. and its existence as a chronic disease, CMS in its proposed Medicare Advantage and Part D rule for the 2026 contract year included a landmark provision to expand Medicare
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Nov. 7, 2024 issue of RADAR on Medicare Advantage Based on a review of select diagnosis codes submitted by Medicare Advantage plans for risk-adjusted reimbursement dating back to 2015, the HHS Office of Inspector General (OIG) estimates that 34 MA contracts received at least $801.3 million in
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by Jon Rogers, Sr. Consultant, Risk Adjustment As the fourth quarter approaches, managed care organizations (MCOs) should focus on optimizing their risk adjustment in-office assessment (IOA) processes to ensure accurate patient assessments, which are crucial for both appropriate revenue realization and quality care management. The following comprehensive
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