HCC Coding & Radv Proxy Audit Services for Medicare Advantage Organizations
Our services help you in many ways. We understand the main areas of Medicare Advantage Organizations. We help MAOs improve their Medicare revenues as well as limiting their audit vulnerabilities.
- Maximization of allowable reimbursement (PMPM) by improving your RAFS
- We reduce your liability/penalty of any kind during statutory audits like RADV/ZPIC/OIG
- Improved reimbursements help to motivate panel providers in a capitated environment
- In turn, the plan-members get the best of the medical services and/or care to stay healthy andstay subscribed with the plan and help it grow
- Complete compliance to statutory norms to meet the welfare objectives
We Analyse Revenue Impact of Prudency of HCC Coding / Clinical Documentation / HEDIS / Star Rating and RADV Audit Vulnerabilities in the Capitated Environment with the Following Objectives:
- To determine the percentages of non-qualifying HCC-Codes derived from the claims, medical records, prospective assessments and provider assessment forms (PAFs) as per the qualifying standards of the CMS guidelines
- To understand the impact of the above-mentioned deviations on your Coordinated Care (CC) Plans including MA plans (Both Part C and Part D- HCCs) as well the Medicaid
- To assess appropriateness of claim coding practices to ascertain whether submitted diagnoses codes via claims are supported by prudent clinical documentation
- Assessment of prudency of your medical record coding process (In-house coders or vendor’s coders if outsourced)
- Assessing whether there is an accurate interpretation of clinical documentation found within the charts by the coders