The January deadline for HHS-RADV-IVA Benefit Year 2022 is right around the corner, but for some health plan leaders, the process feels like it never stops

GLENDALE, Calif. – December 7, 2023 – HRADV-IVA is the annual procedure to assess a health plan’s coding accuracy and determine payment adjustments among ACA plans in the same region. Right now, leaders at many ACA plans are in the heat of audit season, hopeful to have wrapped up chart retrieval efforts by Thanksgiving to give enough time to finish the medical coding audit of the medical records. Closing Health Status Validation (medical coding) reviews and the collection of provider signature attestations will give the IVA Entity time to compile final audit results. In addition, at this point in the audit season, the Demographic & Enrollment Data Validation Audit and Pharmacy RXC Claim Validation audit should be wrapping up if not already completed.

Concurrently, leaders are already looking at next year, analyzing potential partners, and soliciting requests from IVA Entities for information about capabilities and processes.

We understand. Reveleer has been an approved Initial Validation Entity since Benefit Year 2016. Like the health plans we support, we are laser focused on completing this year’s audit, while simultaneously working with customers to set them up for success in the next Benefit Year audit season.

What you need from the right IVA Entity

For leaders already assessing IVA Entity partners, selection frequently comes down to trust, collaboration, and transparency. Trust is earned when the IVA Entity is able to prove deep functional and clinical domain expertise, as well as demonstrate they can bring best practices to the table that allow them to execute. Collaboration and transparency are crucial. Issuers (Health Plans) need to be able to track and verify progress. The right IVA Entity will be strong at building cross-functional relationships and able to rapidly respond to changing HHS & CMS protocol requirements.

How to hit the ground running

Each issuer strives for an error-free audit, but perfection takes people, collaboration, and coordination. An HRADV-IVA is like a race where the starting line and the finish line are fixed points in time, but the track in between in uneven, uncertain, and to some degree, unknown. Health plans need to start planning early, to run the best race possible.

Gather your team early.

Savvy Issuers put their IVA audit teams together early in the year, even prior to selecting an IVA Entity. They identify lead and backup points of contact to manage internal teams and interface with the IVA Entity from pre-program launch, submissions debrief, lessons learned and right back to pre-planning.

Group planning meetings typically start in March, including evaluation strategies about leveraging third-party chart retrieval vendors, identification of chart location volume and defining escalation paths. Health plan audit leads can start to educate internal groups who might support a piece, groups such as provider network & services, so those teams are ready to engage when needed.

Health Plans should identify key staff resources who will pull together the updated mapping documents, crosswalks and source-system screenshots to support the Demographic & Enrollment Data Validation Audit and the Pharmacy RXC Claim Validation Audit. Issuers can collaborate with their IVA Entity to agree upon initial milestones for these audits to ensure timely delivery of the documents, review and communication of any data element discrepancies by early Fall. This will give the health plan ample time to provide replacement documents and/or a work paper(s) with illustration as to the discrepancy and corrective action plan.

Develop a detailed audit work plan and master data preparation.

The right IVA Entity partner should bring process best practices for every phase of the program. Those participating in the audit for the first time need to account for the volume of work required for data mapping at the start of the project and should never underestimate the amount of time required during the final audit submission phase and the various steps necessary prior and during the IVA Entity Senior Official and Issuer Senior Official sign off. In fact, it’s never too early to review data sources and data requirements with your IVA Entity to achieve a smooth and timely final audit submission with minimal to zero errors and warnings.

Attend HHS-RADV-IVA CMS-hosted webinar training sessions.

Savvy leaders stay up to date with CMS instructions and regularly attend Regtap Sessions. Periodically, CMS will announce a change through Regtap sessions or written memos that can impact the audit process. A good IVA Entity partner will remind health plan leaders in advance to attend these sessions, discuss the takeaways afterward, and communicate with the CCIO RADV team on the health plan’s behalf, if necessary.

Coordinate Medical Record & Document retrieval efforts.

Finally, a successful audit requires timely collection of medical records and documents. Know your provider contracts. Advance communication with the providers to notify them that a potential request for medical records has proven timely receipt of the charts for review. When confronted with provider response issues and time is of the essence, some health plans will focus their efforts on the charts they already have in-house to minimize provider abrasion. With a 200-member sample every chart can make an impact.

Want to go deeper on this topic?

We recently hosted a webinar on “Navigating the HRADV-IVA Final Audit Submission Process to Meet Critical Deadlines” discussing how to close strong and start next year on the right foot. Click below to access the replay. 

Reminder: Final HRADV-IVA Benefit Year Deadline Dates

  • Dec. 22, 2023 — IVA Entities may submit initial Audit XMLs to the CMS Audit Tool via Test Mode
  • 8 PM ET, Thurs., Jan. 11, 2024 — Final IVA Entity Senior Official and Issuer (health plan) Senior Official sign off on the XML and Package 1
  • 8 PM ET, Thurs., Jan. 18, 2024 — Final IVA Entity Senior Official & Issuer (Health Plan) Senior Official sign off on Package 2
  • 8 PM ET, Thurs., Jan. 18, 2024 — IVA Entity Senior Official to submit the Inter-rater reliability (IRR) via the CMS Audit tool

No extension will be provided by CMS.

About The Author

Melissa Rector, Director, Customer Success & HRADV-IVA Senior Official Reveleer