Rise Nashville

On March 9-11 Health Data Vision, Inc. (HDVI) attended and exhibited at the 8th Annual Rise Summit in Nashville, TN. With over 600 in attendance there were many common issues brought up in seminars and in conversations, such as the 2015 CMS regulations, concerns around ICD 10 later this year and the importance of proactively mitigating risk of inaccurate submissions.

The Importance of Verify or Delete plus Add and the 2015 CMS rules

vdaHealth plans should make sure they are taking every precaution around avoiding overpayment refund, which would be discovered in a RADV Audit or other imminent audits. A proven method to address this is to review all submitted diagnoses and make sure to delete those that are not truly supported in the chart documentation, instead of only adding. “It may hurt to remove a diagnosis during a Verify or Delete cycle, but it’s nothing compared to what can happen if it gets picked up as an apparent systematic occurrence through RADV,” cites Kristen Joyce, Senior Director of Risk Adjustment at HDVI. If inaccuracies are not identified and removed, then subsequently discovered during a RADV, the cost to the plan in penalties will be much higher than any potential payment the plan may have received for that diagnosis.  During his presentation at the conference, Anker J. Goal (a partner at McDermott Will & Emery), identified four methods to affect validation rate, these include:

• Provider education – documentation and coding
• Identify and delete unsupported codes
• Prospective visits
• Audit readiness: record retrieval and review procedures  

HDVI’s has developed a set of tools within the MRCS platform designed specifically to help health plans proactively mitigate risk, including our Verify Delete or Add Module and our RADV and Mock RADV Modules, as well and as analytics that will allow for the identification of specific error type trends that can be useful input to provider education efforts and care management efforts.

About The Author

Mike Curran is VP of Quality/HEDIS for Reveleer. He has worked in Managed Care for 25 years and brings extensive management and operations experience to Reveleer, as well as proven ability to build high performing, results-focused teams. Prior to joining Reveleer, he came from United Healthcare where he was the National Director for Clinical Performance Improvement. Mike is a graduate of St. Anselm College where he earned a degree in Politics and Boston University where he earned his Master of Public Health degree.