In-home care plays an important role within the US healthcare system. When done correctly, an in-home assessment provides a comprehensive overview of a patient’s health status, which is vital to identify potential health risks and can help ensure optimal outcomes for members who are unable to receive
Read More →The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by CMS to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member, as determined by the Hierarchical Condition Category
Read More →Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified
Read More →It’s time for plans to transition from a waiting period to a move-forward moment After five years of waiting, Medicare Advantage plans now know CMS’s position on CMS and OIG audit extrapolations. It’s time for plans to transition from a waiting period to a move-forward moment, and to
Read More →EDGE, which stands for External Data Gathering Environment, is a common acronym within the risk adjustment space. Often referred to as the EDGE Server or simply EDGE, it’s the endpoint for ACA Marketplace data submissions. While the need for complete, accurate and timely submission of data is
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →Every Medicare Advantage organization and prescription drug plan is required to contract with an independent auditor to conduct a CMS Data Validation Audit (DVA) each contract year. Whether you’re an existing plan or new to the DVA process, it’s imperative to select the right auditor. We know
Read More →ATTAC’s HHS-RADV analytics and chase approach have helped clients reduce the number of charts they’re chasing for HHS RADV by more than 17% in the past three audit cycles. Honing in on critical charts translates into more efficiency, lower costs, and a better opportunity for reducing error rates for
Read More →Incomplete or inaccurate data from provider claims impacts risk scores Health plans are held accountable for the accuracy of data submitted to CMS. Often, plans act as data aggregators and submit data generated by providers and third-parties to CMS. Incomplete or inaccurate diagnosis data may lead to
Read More →Scrutiny related to managed-care risk adjustment practices continues to increase in response to recent Office of Inspector General audit findings and qui tam lawsuits. Health plans often outsource risk adjustment activities and many leading plans take a holistic approach to manage vendors and ensure accuracy and compliance
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