Medicare Advantage, ACA & Medicaid Risk Adjustment
Build Robust Risk Adjustment Programs for Complete, Accurate & Compliant Submission
ATTAC’s risk adjustment experts help health plans, insurers and provider organizations implement effective risk adjustment programs for Medicare Advantage, commercial, ACA and Medicaid products.
We’re one of the nation’s leading risk adjustment auditors for ACA HHS-RADV audits and Medicare Advantage risk adjustment audits and reviews.
Risk adjustment impacts the bottom line, and ensuring complete and accurate diagnosis capture and reporting of illness burden is critical. ATTAC’s experts can help you implement an effective and compliant program.
Risk Adjustment Services
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 how they manage data and use vendors for compliant risk adjustment programs.
ATTAC provides insurers, health plans and provider groups competitive on-shore and off-shore retrospective medical record coding for complete revenue capture in Medicare Advantage, Medicare ACO, ACA and Medicaid risk adjustment.
ATTAC provides issuers with a superior set of audit tools, analytics and reporting, and outstanding coding and transparency. Our comprehensive services support issuers during the annual ACA HHS-RADV audit.
We’ve achieved significant results for plans of all sizes in reducing audit findings, recovering overpayments, and enhancing compliance scores. ATTAC’s experts understand the specific criteria and requirements set forth by the OIG, and have extensive experience navigating audit complexities.
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.
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%.
Risk Adjustment Strategy, Program Assessment Optimization & Advisory
We provide risk adjustment strategy and program optimization support for health plans and provider organizations for Medicare Advantage, commercial ACA, ACOs and Medicaid. Through our comprehensive range of risk adjustment consulting, advisory and auditing services, ATTAC’s industry experts identify opportunities, risks and areas for further program optimization to get the most return on your investment.
- Remain competitive in a rapidly evolving marketplace
- Quickly implement risk adjustment best practices and gain operational efficiencies
- Achieve clarity on how to integrate risk adjustment into value-based care
- Leverage new interoperability rules to enhance risk adjustment operations
- Equip your team to succeed with timely, actionable and customized insights
- Provider education program design and refinement EHR access and bi-directional data sharing strategy
- Review of risk adjustment program coding standards
- Reduce the risk of reputational harm due to negative risk adjustment findings
- Bring risk adjustment to the forefront of your organization with actionable strategies for every department in support of risk adjustment
- Member and provider engagement strategies
- Prospective and retrospective targeting, efficacy and oversight
- End-to-end assessment of encounter extraction, submission, and error correction process
Talk With a Risk Adjustment Expert About How We Can Help You Implement an Effective and Compliant Program
Case Study | Medicare Advantage Risk Adjustment Data Trace
Client Engagement Description
A Medicare Advantage Organization (MAO) in the Midwest provides exceptional benefits to meet members’ healthcare needs. With a rapidly growing membership base of more than 25,000, the MAO established itself as a trusted provider of Medicare Advantage plan products.
Challenges
The MAO transitioned submission vendors and had previously used a large full-service organization to create and submit EDS 837 and RAPS files to CMS for Medicare beneficiaries. This transition resulted in lower-than-expected risk adjustment scores and lost revenue due to what the organization suspected were incomplete data submissions.
By The Numbers
60 Days left before final submission deadline
2M Claims analyzed
25K Medicare beneficiaries
$1.2M Yearly new revenue opportunity
Results
- ATTAC provided the MAO with prioritized target lists for each identified root cause, allowing the organization to remediate outstanding encounters and recapture lost revenue rapidly
- The estimated improvement in risk adjustment score and recaptured lost revenue was $1.25 million
- Using the custom reporting and oversight system detailed by ATTAC, the MAO is projected to mitigate an estimated $1 million to $1.3 million in annual lost revenue going forward
Risk Adjustment Capabilities Brochures
Case Studies
ACA Marketplace Edge Submission Data Trace
Medicare Advantage Risk Adjustment Data Trace
