The new Medicare Advantage RADV audits sampling approach focuses on higher-acuity individuals with codes known to have a higher probability of error. The good news is that this narrows the sample over which the results can be extrapolated, but the error rates themselves are expected to be higher! Plans and risk-bearing MAOs should be well informed here. Ryan McEntee and Tim Murray are excellent resources here. #RADV #MedicareAdvantage #MArisk #ExtrapolationMethodology #actuary #probability
Attention Medicare Advantage and Risk Adjustment Leaders: Are You Prepared for RADV Changes? CMS's updated RADV methodology for PY2018 brings sweeping implications, especially with the enhanced use of extrapolation to project audit findings. These changes make it critical for risk-bearing providers to evaluate not only their coding and documentation practices but also the language in their contracts with Medicare Advantage payers. Ensure your contracts address RADV liabilities and include clear terms for extrapolated repayments. Equally important is a robust compliance program to mitigate risks and protect revenue streams. Stay proactive—this could reshape your financial landscape. Learn more here: https://go.cms.gov/3APdsm1 #MedicareAdvantage #RiskAdjustment #Compliance #ValueBasedCare
