MedAssurant Case Study: Impact of RAD V, Strategic Priorities
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Overview: CMS has signaled plans to materially expand the scope and potential financial implications of risk adjustment audit processes. This report claims we have entered into a new era of heightened focus on practitioner coding accuracy, quality controls on risk-adjusted data submissions, and preparedness for response to regulatory audits within Medicare Advantage and Managed Medicaid health plans. MedAssurant has been assisting clients to prepare for RADV audits, and has gained important insight from that experience. This case study considers the things that health plans can do to prepare for, and maximize the likelihood of a good outcome from, a RADV audit.