#United States #Louisville #Medicare Advantage #RAAPID #RADV Audits

RAAPID's Groundbreaking Webinar on RADV Audits

In a significant development for the healthcare industry, RAAPID, a pioneering company backed by Microsoft’s venture fund M12, has made its executive webinar titled "Don't Wait for the Notice: How to Prepare for RADV Audits Now" available for on-demand viewing. The session, featuring industry expert Wynda Clayton, MS, RHIT, delves into the critical changes in auditing practices that all eligible Medicare Advantage organizations must understand.

The Shift to Universal RADV Audits

During this insightful 40-minute session, Clayton discussed the Centers for Medicare & Medicaid Services (CMS) historic transition from selective to universal RADV audits. This major shift will have far-reaching implications for organizations providing Medicare Advantage plans. Clayton emphasized the importance of viewing RADV audits as more than mere compliance tasks; they should be regarded as a leadership priority that significantly influences financial stability and overall performance.

“RADV audits aren't just a compliance issue – they're a leadership priority that directly affects financial stability and organizational performance,” Clayton stated, underlining the necessity for all executives to prioritize this initiative.

Financial Implications Highlighted

The session brought to light the substantial financial ramifications following recent audit findings. Clayton pointed out that CMS anticipates recovering an additional $4.7 billion from insurers between 2023 and 2032 due to these audits. This alarming estimation pinpoints why organizations should pay close attention to the increasing scrutiny surrounding RADV audits.

The extrapolation methodology can dramatically escalate financial exposure, as illustrated by a case where an initial discovery of a $480,000 overpayment ballooned to a staggering $27 million due to extrapolation effects. Furthermore, Clayton warned that recent audits revealed an overwhelming 69% of Hierarchical Condition Category (HCC) payments were unsupported by proper documentation. This overbilling trend could cost Medicare Advantage plans between $17 billion and $43 billion annually, catalyzing even more rigorous audit processes.

Executive Responsibilities Across Departments

Clayton emphasized a proactive approach, insisting that Chief Medical Officers (CMOs), Chief Financial Officers (CFOs), and Chief Operating Officers (COOs) champion an organizational culture geared towards audit readiness. She delineated specific roles for these executives: CMOs should guarantee clinical documentation integrity and prioritize physician education, CFOs must establish financial safeguards rooted in audit findings, and COOs need to integrate readiness strategies into daily operations to avert inefficiencies and enhance coordination.

Urgency for Operational Change

Highlighting the changes in audit timelines, Clayton noted a significant reduction in the time allocated for these processes. “For 2019, they have definitely cut the audit time by half – you only have, for the most part, 90 days to complete this audit,” she explained, stressing the need for effective teamwork. For example, if an organization has 200 enrollees to audit within a limited timeframe, this underscores the pressing need for an efficient and coordinated response.

To achieve compliance readiness, securing buy-in from all departments is crucial, as Clayton reiterated that such readiness is a leadership-driven initiative rather than a mere reactive compliance necessity.

Expert Insight from Wynda Clayton

Boasting over two decades of experience in risk adjustment and a unique perspective as a former RADV auditor, Clayton provided invaluable insights that resonate with health organizations navigating the complexities of audits. The session was moderated by Chris Lally, RAAPID's Vice President of Operations, who brings over 30 years of healthcare expertise to the table.

For Medicare Advantage Plans, Accountable Care Organizations (ACOs), and other value-based care organizations seeking to cultivate a proactive culture of audit preparedness, the full webinar is now accessible for viewing at RAAPID's website.

About RAAPID

Founded in 2022 by seasoned healthcare technology professionals, RAAPID is at the forefront of enhancing risk adjustment processes through its HITRUST-certified platform. Following its Series A investment from M12, the company is poised to make a significant impact in the realms of Medicare Advantage, the Affordable Care Act, Medicare ACO, and Medicaid programs. For further information about RAAPID, visit their official website at www.raapidinc.com.