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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by Jon Rogers, Sr. Consultant, Risk Adjustment As we move through the second half of 2024, managed care organizations must prioritize member engagement, especially for individuals with chronic conditions. This period presents an opportunity to embrace strategies that encourage essential healthcare visits, such as annual wellness and
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by Jon Rogers, Sr. Consultant, Risk Adjustment As we reach the midpoint of 2024, managed care organizations (MCOs) must take a close look at their In-Home Health Assessment (IHHA) programs, which play a critical role in managing the health of Medicare Advantage and Affordable Care Act populations.
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