| For Immediate release |
CONTACT: new Risk Adjustment Data Validation processRICHMOND, VA— November 14, 2008 CMS has started the full rollout of the new Risk Adjustment Data Validation process. This project began as a five-plan pilot project this past summer, and has now been extended to 30 additional plans, with another 30 plans to be selected in the coming weeks. Letters to the first 30 selected plans went out Monday, November 10, 2008 and it is anticipated that plans will receive their detailed instructions and beneficiary sample lists in early December. Prompt and effective action is needed now to address this issue. The new RADV process has a far greater financial impact than the old validation process. The original process would recover money for beneficiaries with HCCs that were not supported by diagnoses in the medical record. CMS recovered only those payments directly attributable to a specific beneficiary and unsubstantiated HCC. In the new RADV project, CMS will determine a payment error rate attributable to unsubstantiated HCCs in a sample and then extrapolate that error rate to the entire population of beneficiaries with HCCs. The payment adjustment level will increase dramatically, and the real value of the adjustment varies directly with plan size, i.e., the larger the plan, the larger the adjustment. HRP has worked directly with one of our clients during the pilot process and has some valuable experience to bring to bear on this new process. Any plan with a membership of greater than 10,000 members faces a potential multi-million dollar payment adjustment as a result of this process. HRP would like to offer assistance to any clients impacted by this process. Please contact Jeff Grant at (804) 381-4166 ext. 304 or Marc Wise at (804) 381-4166 ext. 303 for more information regarding the audit process or to receive a copy of the audit announcement letter. About Health Risk PartnersHealth Risk Partners, LLC, is a healthcare consulting and technology firm dedicated to helping its clients attain the highest levels of compliance, profitability, and strategic planning. The HRP team has extensive experience working with federal and state healthcare payment methodologies and transforming them into solid business practices for Medicare and Medicaid health plans. HRP helps its clients to manage the Risk Adjustment process for over 1.7 million MA and MAPD lives, including:
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