Understanding the Financial Consequences of a RADV Audit
Undergoing a Risk Adjustment Data Validation (RADV) audit from entities like the Centers for Medicare and Medicaid Services (CMS) or the Department of Health and Human Services (HHS) can pose significant financial risks for health plans and payers. Unsupported Hierarchical Condition Categories (HCCs) found in such audits may be extrapolated to represent an error rate affecting the overall population, impacting organizations profoundly. Even a single unsupported condition in a RADV audit sample can lead to substantial financial implications.
Introducing Veradigm Risk Mitigator
Veradigm's Risk Mitigator, formerly known as Valid8, aims to identify and address risks related to data validation audits effectively. By analyzing claims and submissions data, Risk Mitigator ensures adjustments are made accurately, considering the specific HCCs and risk adjustment models of programs like the Affordable Care Act (ACA) and Medicare Advantage (MA). This tool serves as a crucial component in mitigating the financial impact of RADV audits, safeguarding organizations against revenue loss.
Key Features of Risk Mitigator
Risk Mitigator offers a range of key features to support health plans and payers. It identifies high-risk conditions and providers, providing actionable insights for research, correction, and educational purposes. By distinguishing between 'False Positives' and 'False Negatives,' Risk Mitigator ensures accurate risk assessment. Moreover, it supports both HHS RADV and Medicare RADV audits, offering comprehensive risk mitigation solutions tailored to specific program requirements.
Enhancing Risk Mitigation with Data Insights
Veradigm leverages data mining and extensive experience in data validation exercises to enhance Risk Mitigator's capabilities. By pinpointing conditions prone to coding errors and vulnerable to audits, this tool assists in identifying providers and groups with documentation deficiencies. By combining Risk Adjustment Analytics with Risk Mitigator, organizations can optimize revenue generation while effectively managing audit risks, ensuring compliance and financial stability.
Partnering with Veradigm for RADV Risk Mitigation
Veradigm's Risk Mitigator serves as a proactive risk management solution for health plans and payers, aiming to minimize the impact of Data Validation Audits on organizations. By providing a comprehensive approach to analyzing and addressing potential risks, Risk Mitigator acts as a safeguard against revenue loss and compliance challenges. Partner with Veradigm to leverage the power of Risk Mitigator and secure your organization's financial well-being.