Peak Health Solutions, Inc. can prepare you for and protect you from the CMS Risk Adjustment Data Validation (RADV) audit.
Peak provides RADV Pre-Audits, Mock RADV Audits and RADV Consulting Services to include assistance with appeals and rebuttals. Peak will provide assistance to any plan selected for a RADV audit and offer excellent support services to guide our clients through the complex auditing process.
RADV Pre-Audit Services
Through diligent preparation, our clients can be better prepared for the imminent CMS RADV audit. Our clients utilize Peak’s pre-audit solutions to achieve a variety of objectives.
- To sample a broad selection of medical records to conduct a thorough documentation integrity assessment according to the strict CMS guidelines as well as coding validation to confirm claims submitted were properly documented and identify any missed or unreported codes.
- Thorough operational process review to include medical record request and fulfillment.
- A detailed analysis of the physician query process to ensure proper measures are in place to continually validate the appropriate plan of care for each member and capture the appropriate diagnosis.
RADV Mock Audit Services
Peak’s Mock Audits assist our clients by confirming reported diagnoses as well as identifying related ICD-9-CM coding errors, and uncovering provider documentation errors that can invalidate the reported HCCs / RxHCCs and negatively impact our clients overall Risk Adjustment Factor (RAF) score. The Mock Audit:
- Is modeled after CMS RADV audit process
- Focuses on identification of specific medical records based upon high risk/high dollar criteria
- Reviews coding and physician documentation to confirm reported diagnoses as well as identify related coding errors
- Allows the Plan to see what their true level of risk is if selected for a CMS RADV audit
- Builds internal processes to help prepare for a true RADV audit
RADV Consulting Services
If your Plan has been the subject of a RADV Audit and haven’t been able to fully prepare for it, Peak’s consulting services can assist in getting through the regulatory quandary of a CMS audit. All of Peak’s consulting specialists provide fully customizable and plan specific solutions. Peak’s Specialists:
- Aid with the CMS rebuttal and appeals process
- Assist with the Plan’s attestation statement collection process from Providers
- Advise you on the document dispute process
- Assist with the appeal/rebuttal of CMS’ calculation of the Plan’s RAF payment
