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

It’s not Obamacare anymore. It’s our national health-care system.

By Drew Altman and Larry Levitt July 29 Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation. Larry Levitt is senior vice president of the Kaiser Foundation. Republicans failed to repeal and replace the Affordable Care Act early Friday because of divisions within their own ranks, and because they tried not only to repeal and replace the ACA but also to cut and cap the Medicaid program, generating opposition from many red-state governors and their senators. But most of all, they failed because they built their various plans on the false claim — busted by the Congressional Budget Office — that they could maintain the same coverage levels as the ACA and lower premiums and deductibles, while at the same time slashing about a trillion dollars from Medicaid and ACA subsidies and softening the ACA’s consumer protection regulations. Had they succeeded, they would have won a big short-term victory with their base, which strongly supports repeal, but suffered the consequences in subsequent elections as the same voters lost coverage or were hit with higher premiums and deductibles. ...
Read More

Where to Now? True North Again

By Kevin Mowll, Executive Director of the RISE Association The failure of the Republicans to repeal, replace, or wreck ObamaCare is a wakeup call for everyone, not just Republicans. While the RISE Association steers away from purely political commentary, the lesson of this protracted political mess needs to be called out for the sake of putting our priorities straight around public policy regarding healthcare reform. In the attached Wall Street Journal article, which suggests that bipartisan solutions are the only remaining way forward, the author proffers hope that the blistering truth will be obvious to all the participants in the 7-year-long fracas around repeal and replace. The bloodied players may still brood in frustration that their political wills were not enough to win, but the author wonders if cooler heads will prevail. I, for one, am not so sanguine; yet I can only hope. https://www.wsj.com/articles/republicans-search-for-answers-can-they-find-any-across-the-aisle-1501259286 The lesson I take away from the many years of wrangling is that the ObamaCare political football games demonstrates that political wills are not the way forward. They lose sight of the True North issue at hand. Rather, the failures of both political parties in arriving at a bipartisan solution signals the fact that what is good for America is good healthcare policy, not political prowess over rivals. Governing from the fringe is not sustainable in a democracy. ...
Read More

Upcoming Conference

 

RISE West 2017 

Featuring three pre-conference workshops, and five tracks covering 20+ in-depth session topics, this event is an extraordinary value-proposition you don’t want to miss. Hear from industry thought leaders, as well as health plan and provider group experts who will share practical insights and updated lessons learned from the trenches on critical topics in risk adjustment, quality improvement, data management, coding compliance & more!

More

Upcoming Webinar

The Encounter Management Best Practices Playbook

What encounter best practices can managed care plans put into place to help them manage the pace of change in formats, rules and regulations? What do managed care plans have to stop doing if they want to ensure business continuity with their encounter operations in the face of change and bleeding revenue? What can you do to make sure your plan isn’t one of the ones that figured these things out too late? Join us to get answers to these questions and more on September 12th.

 

Connect With Us

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