Medical Risk Adjustment Compliance
Risk Adjustment Oversight
Our team of professionals have served as the Initial Validation Auditor (IVA), developed risk adjustment policies and procedures for the largest healthcare payers, and conducted numerous Risk Adjustment Data Validation (RADV) audits. We have completed end-to-end risk adjustment assessments of coding and data submission, QA controls, and information governance for risk adjustment audits for government and commercial health plans.
- Payors: Our efforts have included serving as the IVA or external audit for risk adjustment audits for Medicare, Medicaid, and Commercial plans. Additionally, we have served Medicare Advantage payors in conducting mock RADV assessments and identifying data capture and program risks.
- Providers: We have supported providers in identifying, testing, and reporting gaps for improvement and compliance risk areas for value-based care contracts related to with risk adjustment payments. These involved routine compliance audits, qui tam and government investigation defense, proactive reporting of EHR system errors, training of coding and physician staff, and review of internal policies and coding guidelines.
To learn more, see our blogs on Risk Adjustment or reach out to James Rose, Sam Cunningham, or Lorraine Aniello
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SunHawk Consulting
2550 E Rose Garden Ln.
Unit 72016
Phoenix, AZ 85050
info@sunhawkconsulting.com
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