Welcome to a brand new episode of Care Decoded! In this episode, host Mark McKeown is joined by renowned risk adjustment and coding expert Colleen Gianatasio to kick off a special two-part series diving into CMS’s heightened focus on RADV (Risk Adjustment Data Validation) audits. As Medicare Advantage plans face unprecedented scrutiny with CMS now pledging to audit all eligible contracts every year, the stakes have never been higher for compliance, documentation, and risk management.

Together, Mark and Colleen unravel the far-reaching impact of these changes across the healthcare industry, from the increased resource demands on health plans to building a culture of compliance and leveraging people, process, and technology for audit readiness. Drawing on her expertise, Colleen shares actionable strategies for integrating risk adjustment compliance into the fabric of organizations, explains the most common pitfalls in documentation and coding, and explores how AI and prospective tools can improve audit outcomes.

Whether you’re part of a health plan, provider group, or just interested in the world of healthcare compliance, this episode is packed with practical advice and insights on navigating the evolving landscape of RADV audits and value-based care. Tune in as we decode the latest industry challenges and get ready for the next episode, where we’ll dive deeper into the provider’s role in RADV success.

Timestamps:

00:00 Medicare Advantage Under Scrutiny

06:18 Proactive RADV SWAT Strategy

07:18 Continuous Provider Communication Strategy

12:17 Top Coding Issues in Risk Adjustment

15:29 Optimizing Risk Adjustment with Data Analytics

19:34 Risk Adjustment Reporting Overhaul

23:09 Prospective Risk Beats Retro Adjustment

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

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