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


Log on to Your Rise Account

Forgot your password?
Create an Account

Association Sponsors

Latest Posts

Keep M.E.A.T. on Your List for a Healthy Audit

By Jeanmarie Loria, Advize Health, LLC If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to each patient, taking into consideration their ailments and other demographics. With every payment model comes a specific set of audit and review requirements that must be met to maintain the integrity of the system, and this is where MEAT (Monitor, Evaluate, Assess/Address, Treat) comes in handy. In a face to face visit M.E.A.T. maybe found in the chief complaint, history of present illness, review of systems, physical exam, assessment and/or plan....
Read More

Getting It Right: True North in Healthcare Reform

The movement to repeal and replace "ObamaCare" created so much political noise that clear thinking has been hard to come by. The 2010 legislation that created the marketplace for individuals and small business (the Affordable Care Act or ACA), has almost evolved into a political Rorschach test. The more that politicized options and alternatives to repealing, replacing, or repairing it were discussed, the harder it was to put into focus the original problems the legislation was designed to address. Nevertheless, the rancorous divisions over what needs to happen to fix problems in the individual insurance market remain a distraction from the real issue at hand: the cost of healthcare weighing down the economy and what we need to do to fix it. With all the intense debates swirling around this topic, an impression emerges that “solving the ObamaCare issues” is something that must be accomplished as an isolated matter, discrete and independent of other problems. The heated debates concentrate on the mechanics and tactics required to solve the "uninsured problem", the "under-insured problem", and for some, the federal budget problems created by the subsidies for low-income enrollees in these plans. This single-issue mono-vision obscures a reality that must be addressed. This perspective completely misses the fact that something is going on that is far more corrosive to the wellbeing of all of us as consumers of health care, as taxpayers, and as a nation: something that overshadows the tug ‘o war over ObamaCare. The critical and overlooked issue is that health care expenditures in the U.S are at least twice as expensive as other nations, which consume so much of the national economy...
Read More

Upcoming Conference

 

Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.

More

Upcoming Webinar

Successful and Meaningful Techniques for Integrating Risk and Quality Interventions

Quality measurement and risk adjustment regulations are increasing and the financial impact upon health plans is progressively driving accountability and influencing profitability through payments, penalties, and bonuses. To improve performance and optimize risk and quality payments, Health Plans need to streamline processes, employ best practices for data capture, and focus on strategic interventions that use a member-centric approach.  

Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.