Picking the Right ACA HHS RADV Audit Partner Is Critical

ATTAC Consulting Group is a leader in performing ACA HHS RADV audits for national, regional, BCBS and local commercial product issuers.

Efficiently validating enrollee HCCs, minimizing error rates, and validating enrollment and drug (RXC) data is critical to a plan’s ACA risk adjustment transfers. ATTAC Consulting Group provides issuers with a superior set of audit tools, analytics and reporting, and outstanding coding and transparency. Our comprehensive services support our issuer clients during the annual ACA HHS RADV audit.

Top 5 Reasons Plans Select ATTAC for ACA HHS RADV Audits:

The ACA HHS RADV audit can impact millions of dollars in risk transfers, and minimizing error rates is critical. We’ve audited hundreds of HIOS IDs since the first year of the audit. ATTAC’s clients choose us—and stay with us—because we provide:

  • Refined analytics to design and maximize chart-chase strategies
  • A suite of audit tools, portals and detailed reporting that allows clients to rapidly pivot and close gaps
  • A coding approach that provides outstanding HCC validation accuracy and IDs new HCCs
  • Experienced audit managers who know the critical issues that impact audit results
  • A deeply experienced ACA HCC coding team

ATTAC has deep experience performing large-scale RADV audits for ACA issuers and Medicare plans. Issuers trust us to provide critical feedback via our web-based portals, gap reporting and analytics. We are HITRUST certified and securely manage all data and reporting to CMS. Our audit framework includes:

Demographic & Enrollment Validation

  • We’ll use previous work papers where available
  • Edge Server to source enrollment data validation
  • Deidentification ID with enrollment and claims
  • Original source enrollment documentation
  • Plan of enrollment, rating area and premium validation
  • Date of birth, sex and effective dates
  • Familiarity with major enrollment systems

In-depth Analytics to Support Chart-Chase Refinement

  • ID all HCC Dx provider/member combinations
  • Establish chase priorities to maximize efficiency
  • ID risk adjustment valid providers with or without HCCs
  • Add plan provider contact data to drive chase
  • Group common record chases
  • Provide data on open HCCs and provider charts still available to validate those HCCs throughout the audit

Flexible Medical Record Acquisition

  • We support auditor-acquired, plan-acquired or shared-chase options
  • Professional record technicians
  • National capabilities
  • Electronic EMR extracts
  • Fax or mail
  • Secure FTP transmission

Outstanding Medical Record Coding

  • Web-based coding outcome reporting for transparency
  • Certified U.S.-based coders
  • ACA HCC and HHS-RADV experienced coders
  • Extensive training on specific HCCs and Dxs
  • Multi-stage coding and QA
  • Transparent coding results and appeals process
  • Inter-rater reliability reporting

Plan & HHS Reporting

  • Real-time update on findings
  • Web interface for issues management
  • Detailed summary findings to plan
  • All medical records to plan
  • Upload all findings to HHS

Secondary Validation Auditor Support

  • Assembly of all records and findings
  • Data transfers to the SVA
  • Management of SVA questions and inquiries
  • All SVA data packaged and provided to the plan

Reporting & Appeals Support

  • All findings and records provided to the plan
  • Charts and diagnosis coded by page and date