CMS Is Engaging Recovery Audit Contractors to Recover Over Payments to Health Plans and Conduct Condition-Specific RADV Audits
Irvine, CA – May 31, 2016 – Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare, Medicaid, and Exchange programs, is now providing professional services to assist Health Plans through RADV and Condition-Specific RADV Audits.
CMS will utilize Recovery Audit Contractors (RAC) to conduct these audits. These audits will be disruptive and costly to Health Plans, and will result in severe penalties to plans that are subject to overpayments. Currently, CMS audits about 5% of Medicare plans. With the combination of conventional RADV audits and the Condition Specific Audits, CMS’s goal is to audit 100% of the Medicare plans. The RACs are paid on a contingency basis from recovered accounts, and are therefore highly incentivized to report discoveries to CMS.
“Submitting quality encounter data to CMS is more imperative than ever before,” said Kathy Feeny, President and Chief Executive Officer of Dynamic Healthcare Systems. “The combination of Dynamic’s team of industry experts and Dynamic’s proprietary software is a reliable and proven solution for the management and administration of health plan’s Risk Adjustment Programs and encounter submission processes,” Feeny added.
The addition of Condition Specific RADV Audits will require plans to perform reverse suspecting analysis to identify submissions that may not be supported by accurate chart data. These diagnoses suspects will be discovered by the RACs. Solutions have to be implemented which will identify not only the inaccurate submissions resulting in over and underpayments; but also the providers who may require oversight with their Medical Record coding and documentation practices. Programs inclusive of training and incentives should be implemented with provider networks to reduce RAC findings.
Dynamic’s robust software provides Medicare Advantage health plans with an enterprise-wide solution that provides a strong Risk Adjustment strategy that ensures maximum and accurate submissions and payments. Dynamic’s integrated software solutions are designed to ensure health plans meet the complex compliance and data processing requirements that the Centers for Medicare and Medicaid Services (CMS) establishes, monitors, and enforces. The Dynamic application integrates the various sources of data to create a single view of a Plan’s membership in order to deliver high-quality managed care and consistently meet the compliance requirements as well as any revenue management challenges they face.
About Dynamic Healthcare Systems
Dynamic Healthcare Systems, Inc. delivers comprehensive enterprise software solutions and services for health plans with Medicare Advantage, Medicaid, and Marketplace lines of business striving to succeed amid new and evolving regulatory requirements. Headquartered in Irvine, California, the company brings world-class and innovative solutions to companies serving the government-regulated healthcare population. For more information, visit www.dynamichealthsys.com or call 949.333.4565.