The Problem: Significant Error Rates

Whether you’ve been notified of an audit or preparing for the possibility, the CMS timeline is tight. Verisk Health provides project management, record retrieval, quality assurance and assistance in selecting the medical records that best support the HCCs targeted.  We also assist clients by documenting expected methodologies and anticipated payment adjustment in advance of CMS extrapolations. If requested, we can support plan appeals of CMS determinations.

The Solution: Audit & RADV Support

Features

  • Pre-RADV Support
  • Medical Record Retrieval
  • Medical record data capture through Chart Navigator™
  • Best record selection
  • Extrapolation
  • Appeals and negotiation

Benefits

  • Tracking and reporting databases and scrubbing of all appropriate provider data in preparation for record retrieval
  • RADV records will be retrieved on a priority, expedited basis to ensure as many as possible are retrieved in a timely manner
  • Assist in diagnosis capture and record tracking
  • Assist in the selection of "Best Medical Record" using proprietary algorithm
  • Estimate the potential financial impact of the audit result based upon lost, sustained and gained HCCs
  • Assist the client in validating the sampling methodology and confirming the findings of the CMS records review

Next Steps

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