Atlantic Information Services, Inc., publisher of Medicare Advantage News and Health Plan Week, is pleased to announce its April 3 webinar, RADV Audit Extrapolation: What Steps Should Medicare Advantage Plans Be Taking Now? See webinar details at http://aishealth.com/marketplace/c2a14_040312.
The final methodology released by CMS Feb. 24 for calculating and extrapolating errors found in risk adjustment data validation (RADV) audits of Medicare Advantage (MA) plans quieted some fears about the potentially huge consequences of even unintentional errors. CMS agreed to institute a fee-for-service adjuster to reflect the error rate in FFS claims, put off the start of audit extrapolation to use later data, and allowed MA plans to submit multiple medical records for beneficiaries whose condition coding is being audited.
However, there are numerous unanswered questions, and Medicare Advantage plans must begin to prepare now without official answers from CMS, since RADV audit extrapolation seems likely to start this fall, and hundreds of millions of dollars in overpayment recoupments annually are at stake.
On April 3, Bruce Merlin Fried, the former health plan overseer at CMS predecessor HCFA, and Thomas Hutchinson, the former head of CMS’s Medicare Plan Payment Group at the time it developed the RADV program, both currently with SNR Denton, LLC, will provide valuable insights on how to prepare for RADV audit extrapolation. During the 60-minute presentation and 30 minutes of Q&A, the speakers will provide reliable strategic information on such key questions as:
What basis will CMS use to pick MA plans for RADV audits?
How will the RADV policy be modified when and if CMS audits small MA plans?
How will the FFS adjuster be determined?
How will CMS determine, in the case of multiple medical records submitted for a beneficiary by an MA plan, which is the best medical record for RADV auditing?
Where does the HHS Office of Inspector General fit in this process?
How should a plan assess potential liability under RADV extrapolation?
Is this the end of the RADV methodology story, or is there another “chapter” to come?
Visit http://aishealth.com/marketplace/c2a14_040312 for more details and registration information.
AIS develops highly targeted news, data and strategies for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. Learn more at http://www.AISHealth.com.
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