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

Find More, Spend Less, Take Control: Leveraging Technology to Improve the ROI on Risk Adjustment

Due to changing market dynamics, there is increasing pressure for risk-bearing organizations to improve the effectiveness of their risk adjustment programs. Several trends present pervasive challenges—for example, increasing number of risk-adjusted lives, rising coding intensity factor, and heightened focus on compliance. Risk adjustment departments are constantly being asked to do more with less. Organizations that can leverage risk adjustment as a strategic asset and effectively utilize technology will be best positioned to achieve accurate risk and revenue capture while simultaneously decreasing costs. Streamlining Risk Adjustment with Technology As organizations seek to modernize their risk adjustment operations, there are several high value technology initiatives they can explore. Rather than blindly reviewing charts across the entire membership, organizations can use natural language processing (NLP) technology on medical records to help identify risk adjustment gaps, both for additional HCC capture and for potential deletes. Health Fidelity has been able to consistently demonstrate with our clients that NLP-assisted coding delivers superior results as compared to human-only reviews, both when our clients are conducting the coding and when our coders provide the coding capacity....
Read More

Boomerquake

Medicare products are expected to be the fastest growing insurance sector over the next 10-years. At the same time, Boomers are transforming care delivery, from aging-at-home services to convenience-driven alternate sites of care such as retail clinics, telemedicine and wearables to anti-aging nutraceuticals. Opportunity abounds. What’s clear is the need to understand Boomers – what’s important to them, what truly matters to them, and why they do what they do – has never been more important. For marketers this means a shift in orientation from brand promotion to individual inspiration, from features and functions to emotional appeals that move people to act and engage. It’s about connecting with Boomers around personal, relevant motivations and deep, sometimes even unconscious desires, like freedom, happiness, renewed goals, or simply the ability to enjoy life. A quick snapshot of 75+ million Boomers ages 51 to 69: ...
Read More

Upcoming Conference

 

RISE Risk Adjustment Academy: CMS & HHS Risk Adjustment 101 and HCC Coding Accuracy

Designed as an introduction or refresher that covers all the bases when working with Medicare Advantage or on commercial health insurance exchanges lines of business. The workshop program is a holistic orientation to the risk adjustment panorama and deep dive into HCC coding for accuracy. With a mix of health plan and provider audiences, a powerful environment for interaction and collaboration is built over two-days. You will gain insight, tips, and best practices to build upon your knowledge of risk adjustment, coding, and documentation.

More

Upcoming Webinar

Protecting Risk Adjusted Revenue in Small and Mid-Tier Health Plans

If you’ve ever heard the phrase “working without a net” then you’ve heard a phrase that accurately describes the status of risk-adjusted revenue for small and mid-tier health plans. And when you’re working without that net, you’ve got to secure every dollar possible. Easier said than done given the inherent complexity of the encounter management lifecycle and the constant changes and updates that continue to vex managed care plans of all types. What’s required is a simple, best practice approach to encounter data management that is built to serve the needs of health plans regardless of their size. Implementing a best practice approach for small and mid-tier managed care health plans to protect and grow risk-adjusted revenue begins by joining Edifecs for this impactful, actionable webinar.

 

Connect With Us

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