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The Risky Business of Claims-Only Risk Adjustments

With over 95% of Medicare Advantage risk adjustments routinely coming from claims, why don't health plans audit them? Failing to do so causes inherent RADV risk. Learn why it's crucial for health plans to not only audit their retrospective chart reviews and prospective assessments but their claims too. You'll also gain a thorough understanding of the ramifications for choosing not to audit claims during our free, live webinar.

Kim Browning, Executive Vice President of Cognisight, provided practical advice and specific action steps you can take to easily incorporate claims-only audits into your risk adjustment program and minimize RADV risk.

 Specific topics covered:

  • HCC selection insights from recently audited plans
  • Prioritizing claims with a single source, < 1% average distribution, and MA/Duals outliers
  • RAC Audit considerations
  • Glimpse at GAO recommendations

The webinar materials are available below.