How risk adjustment coding validation gives health plans more certainty
Compliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to their risk adjustment programs. When CMS selects plans for a risk adjustment data validation (RADV) audit, they need to have a high degree of certainty that their diagnoses submitted for reimbursement are valid. So, what’s the solution? We look at the benefits of coding claim validation with Lesley Brown, Cotiviti vice president of Risk Adjustment.