Risk Adjustment Optimization, Compliance & Program Development
Optimization of Medicare and ACA risk adjustment programs requires more than hiring vendors for in-home assessments, analytics, and retrospective chart review. ATTAC is a leader in helping plans optimize risk adjustment programs and monitor compliance.
Risk Adjustment Operations Excellence & Strategy Review
Most plans benefit from a periodic review of risk adjustment programs and vendors. Selecting the right targets and mix of prospective, concurrent and retrospective efforts has a huge impact on ROI. Using vendors effectively and applying controls to monitor accuracy and completeness of data are critical for revenue capture, compliance and to avoid false claims risk in Medicare Advantage, ACA and Medicaid risk adjustment. Learn more about ATTAC’s RA Operations Assessment and Program Optimization.
Risk Adjustment OIG & RADV Audits, Compliance & Overpayments
OIG Risk Adjustment audits and MA RADV audits continue to target data accuracy and over-payments. OIG recommends a plan to implement analytics to identify potential data issues and proactively clean up data. ATTAC’s Risk Adjustment team assists plans with implementing effective compliance controls.
CMS’s RADV Audit Final Rule makes clear that CMS will recoup identified individual overpayments, and beginning with the 2018 plan year CMS will collect overpayments determined through extrapolation. ATTAC can guide your organization in developing tools and processes to identify potential overpayments. We provide industry-proven models, processes, and know-how to ensure compliance. Learn More about ATTAC’s Risk Adjustment Compliance Support Services.
Risk Adjustment Data Trace & Data Management Testing
Risk Adjustment Data Leakage. As data moves from clearinghouses to claims systems, combines with delegate data, moves into data warehouses and on to EDS and Edge Servers, critical diagnosis can be lost and never submitted. Stop the leakage. ATTAC’s Data Trace and Data Leakage Assessments can improve ROI by 5 to 20%.
Learn more about ATTAC’s Risk Adjustment Data Trace and Data Management Testing
Risk Adjustment Program Design & Optimization for Providers
ATTAC assists providers in developing the techniques, infrastructure, analytics, CDI programs, and education tools needed to manage risk adjustment at a whole new level and assure revenue capture from your value-based or percentage of premium contracts.
Risk Adjustment Auditing
- ACA HHS RADV Initial Validation Auditing (IVA) ATTAC is one of the nation’s most trusted ACA HHS RADV auditors
- OIG and MA RADV reviews
- Chart over-reads to monitor vendor or internal chart coding activities
- Chart over-reads & vendor validation. Enhance your internal and vendor coding oversight with a third-party over-read audit
Other Risk Adjustment Program Advisory & Design Services
- Implementing effective prospective in-home programs and compliance oversight
- Retrospective chart coding over-read audits to test coding
- Risk adjustment vendor use evaluation and oversight
- Risk adjustment compliance controls, analytics design and risk mitigation
- Investigation support
