Risk Adjustment Data Validation (RADV) Audit Support

  • Simulated RADV Audits
  • Gap Analysis (documentation vs. coding)
  • Provider education for clinical documentation improvement
  • Methodology for RADV audit that helps in determining the best records for CMS submission
  • Coder education based on RADV Audit requirements
Case Studies
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).