11 May Off
We have been describing multiple aspects of risk adjustment compliance in our newsletters, along with helpful tips on documentation and coding. CMS requires PACE, Medicare Advantage and similar organizations to submit all relevant diagnosis codes at least once yearly. A “relevant” code is one that impacts Part C or Part D payment. Failure to submit all relevant codes is an important compliance issue. To help our clients with the dual challenges of optimizing compliance and revenue, we introduce a new service– our RAPS Data Integrity Audit.
Anyone working with RAPS data understands the many opportunities to “drop” data that would otherwise feed the diagnosis clusters that impact payment. From clear diagnosis, to accurate and specific ICD-10 coding, data extraction, submission and error reports, the opportunities for dropping RAPS data present a challenge to data completeness. We are pleased to provide a service that determines if codes from your EMR have actually been accepted into RAPS to impact payment for the current or upcoming payment year.
RAPS Data Integrity Audit also helps to satisfy some compliance requirements, such as internal auditing and monitoring requirements. Don’t be lulled into assuming your valuable RAPS data has been effectively submitted – nearly all programs we audit have missing RAPS data. We recently audited two PACE organizations and recovered thousands of ICD-10 codes that were properly documented and coded, but had not completed their way into RAPS effectively. We provided the clients with submissible files that produced a happy improvement in average risk scores.
Please contact us to help you with assuring your program’s diagnosis data is completely submitted.