OSI’s RADV audit services help insurance firms ensure their plans are CMS-RADV audit ready.
Insurance companies providing Medicare Advantage (MA) plans have to face an RADV audit during each calendar year after the HCC data has been collected and reported to CMS and the payment has been made by CMS to the MA health plan. CMS performs this audit to validate the accuracy of the HCCs submitted by MA plans for payment, thus reducing payment errors. Outsource Strategies International (OSI) offers RADV (Risk adjustment data validation) audit services for insurance companies to help their plans become CMS-RADV audit ready.
Following the CMS RADV audit model, the company provides mock-audit services to confirm reported diagnosis and identify ICD-9-CM coding errors. This helps clients to streamline the internal processes for an authentic CMS audit. The professionally trained team identifies specific medical records based on the high risk/high dollar factor, and reviews physician and coding documentation.
OSI also provides RADV pre-audit and consulting services. Pre-audit services include sampling a set of medical records for detailed documentation based on CMS guidelines, carrying out a complete operational process and analyzing the physician query process to ensure the right measures are employed.
Focused on varied Medicare Advantage Plans’ needs, comprehensive RADV consulting services are offered to help clients prepare better for the imminent CMS RADV audit. Any documentation issues in the medical records that may not pass a CMS audit are easily identified and corrected.
“Our certified professional medical coders can abstract all HCC codes to support MA plans in completing accurate risk assessment of their membership and submit accurate and complete data before CMS deadlines. Our auditors ensure that all requirements and guidelines such as provider signatures, credentials, and all documentation standards have been met for an actual audit,” says a senior solutions manager of OSI.
With OSI’s RADV audit services, clients can also benefit from HEDV compliance, reliable data and reports, HIPAA compliant services and competitive pricing with 30-40% cost savings.