Health Data Vision's Bryan Lee, VP of Payer Solutions & Chief Compliance Officer, and Jay Ackerman, President & CEO, spent February 13, 2019 with the HHS-CMS RADV team and industry peers talking about lessons learned from the 2017 IVA submission year. We are pleased to be able to share insights from this meeting, which may affect your 2018 IVA audit.  

Key takeaways for 2018 audit include: 

  • New addition of Pharmacy validation in 2018 
  • Confirmation that plans smaller than $15 million will not be subject to the 2018 audit 
  • Challenges using third-party retrieval services that put up barriers to plans accessing charts 
  • Challenges with provider pushback 
  • Standardization of mapping documentation  
  • Timelines and protocols for starting/completing the audit 
  • Sample size changes 
  • Clarification on/mandating coding guidelines, such as chronic conditions 
  • Comments/feedback from plans for Benefit Year 2019 
  • Appeals process for discrepancies  
  • Streamlining the upload process and CMS audit tools 

The good news is that HCC validation rates are improving. CMS is interested in understanding why rates have gone up and share best practices. 

Now that Health Data Vision and its clients have had three years of practice IVA audits, 2018 will be the second year that the results are going to financially count for health plans that qualify. Our clients are in a good position to reap the benefits of our experience and platform custom-built for IVA.  

Just a reminder, IVA companies must choose their auditor no later than then end of April. If you are interested in speaking with Health Data Vision about your audit and to see a demo of our fully transparent platform that allows plans to see what is happening during their audit, every step of the way, please email or call us today at (866) 969-3222. 

You can watch the webinar in its entirety here:  

Key Takeaways from the HHS-CMS IVA Lessons Learned Meeting - 2017 Benefit Year

 

About The Author

Reveleer is a healthcare software and services company that empowers payers in all lines of business to take control over their risk adjustment and quality improvement programs. The Reveleer platform enables payers to independently execute and manage every aspect of provider outreach, retrieval, coding, abstraction and reporting – all under one single platform. Leveraging its technology, proprietary data sets, and subject matter expertise, Reveleer also assists payers with full record retrieval and review services to support financial performance and improved member outcomes.