Medicare RADV User Group

After talking with colleagues at our RISE Nashville conference as well as the risk adjustment forum in Chicago at the end of May, we were encouraged to create a user group for the risk adjustment leadership of Medicare Advantage plans.  These representatives included plans that had been through a RADV audit as well as those who hadn’t yet. Their interests in forming a user group were similar, regardless of whether they had already gone through the RADV experience:

  • Sharing the plans on preparation and execution once the RADV audit notice arrived
  • On-going learning around best practices, learning directly from peers and colleagues about risk mitigation
  • Easy access to peers willing to share their learned lessons and insights inside the user group calls as well as offline on an ad hoc basis
  • A comfortable place to bring questions, problem-solve or test new ideas before launching them
  • A forum to create a support network of colleagues across the country, and to form a network of friends to meet-up with at the conferences

What Is Being Discussed?

This is a new user group but we have already mapped out some topics of interest.  We will add-on, expand and evolve based on the needs of the users:

  1. What kind of organizational structure, roles and staffing do different RA organizations have?
  2. Identifying the pros and cons of outsourcing or insourcing different functions for a RADV audit.
  3. How to organize the roles and tasks in advance of the RADV audit?
  4. Once the audit notice is received, what are some best practices in project management and orchestration?
  5. What level of errors did your organization encounter?
  6. What are the most common unvalidated HCCs you came across?
  7. What is the CMS definition of the benchmark FFS error rate against which you will be rated for variance?

Who Will Be Involved?

This user group of peers will be organized mostly at the department director and manager level, but we would hope to have the leaders invite their staff and analysts to join the calls, as well.  RISE will organize and facilitate the meetings.  We will garner specific topics from the users and identify who will present or talk about the topics, apart from allowing free discussion and dialogue during the sessions.  The agendas will be managed to stick to roughly an hour time slot, unless the group feels like a longer session should be scheduled.  Also, ad hoc inclusion of other functional areas would be appropriate based on the agenda topics, such as regulatory compliance, finance, provider relations or clinical departments, for example.

 

How to Get Involved

Send us an e-mail requesting participation, the type of topics you want to discuss and we will organize the group and the meeting times.  We will reply with a link or phone number to call, the topics that the group is discussing and the meeting times.

RISE Contact:   Kevin Mowll  kmowll@risehealth.org 831-465-2283


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