Effectively identifying and processing Medicare Advantage (MA) risk adjustment data is no simple matter – it requires extensive experience in data science, claims and encounter data analytics, actuarial science, CMS regulatory and sub-regulatory guidance, and up-to-date, HIPAA-compliant risk adjustment software platforms. Without these skills and technology, valuable MA risk adjustment data that would otherwise be submittable to CMS and generate increased revenues for your organization may be overlooked, ignored or ineffectively captured/submitted by inadequately equipped Medicare Advantage Organizations (MAOs).
The more an MAO “leaks” submittable MA risk adjustment data, the more downstream capitation or shared savings revenues the provider loses. An annual audit coupled with ongoing monitoring of a provider’s contracted-MAO’s records and performance pertaining to the intake and processing of MA risk adjustment data, may therefore be advisable under certain circumstances.
Frier Levitt works with healthcare data analytics professionals to provide first and second tier MA entities, such as Management Services Organizations (MSOs), Accountable Care Organizations (ACOs), Independent Practice Associations (IPAs), and Clinically Integrated Networks (CINs), with the knowledge and technological capacity needed to perform such audits and monitoring. If leaks are identified, Frier Levitt is able to litigate to insure they are patched and that your organization is compensated for lost revenues.
Contact Frier Levitt today to speak to an attorney about optimizing your organization’s MA Risk Adjustment Data generated revenues.