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Are Medicare Advantage Organizations being Honest with Providers? Top 5 Lessons about Risk Adjustment Data in Medicare Advantage
June 15 @ 12:00 pm - 1:00 pm
OIG’s recent report on Humana’s alleged $200 million overpayment from Medicare Advantage briefly touches upon an issue far too many practices ignore – the potential for loss of substantial risk adjusted capitated revenues resulting from an MAO’s failure to fully capture and submit all relevant patient diagnosis codes, which could result in the loss of millions in capitated revenue. Frier Levitt is pleased to present an educational webinar for providers, ACOs and industry friends. We will discuss methods and options for addressing this issue to get your downstream-contracted MA provider group paid more accurately. You’ll get answers to questions such as:
- What are the recent findings by the OIG regarding Humana as it relates to underpayments by CMS resulting from Humana’s apparent failure to submit all risk adjustment data it should have?
- Am I getting all that my healthcare data is worth?
- What is healthcare risk adjustment data and how does it relate to patient risk scores and, ultimately, risk adjusted capitated payments?
- Can I Audit my MAO to ensure they are capturing and properly submitting all of my practice’s risk adjustment data to CMS?
- Where does my healthcare risk adjustment data go?
- How can my healthcare risk adjustment data be lost along the way?
- How and why do underpayments by MAOs to practices in risk adjusted capitated arrangements occur and what can be done about that through contract renegotiation or, if necessary, litigation (or the good faith threat of litigation)?
Jonathan Levitt is the Co-Founding Member of Frier Levitt and Jason Silberberg is a a senior Associate in the Firm. The two founded the Firm’s Risk Adjustment Litigation Group to protect providers from MAO abuse and were recently successful in achieving a near eight-figure settlement on behalf of a technology company that rendered consulting services to a very large provider group in connection with a risk adjusted capitated payment arrangement. Their insights into this topic are not to be missed!
 All parties have denied wrongdoing and the settlement is confidential.