Medicare Advantage Organizations (MAOs) need to find ways to increase the accuracy of diagnosis coding, locate clinical indicators that support diagnoses, and prevent inappropriate diagnoses from being submitted to CMS.
New government policies from the Centers for Medicare and Medicaid Services (CMS) are threatening the bottom lines of MAOs. Between the Risk Adjustment Data Validation (RADV) final rule and the major revisions proposed to the CMS-HCC risk adjustment model, MAOs need to find ways to increase the accuracy of risk adjustment coding.
Read the whitepaper to learn three key strategies health plans can use to navigate the shifting seas of risk adjustment:
- Use purpose-built technology to ensure accurate coding
- Target physician education on documentation
- Use concurrent and prospective review where appropriate