Risk Adjustment Compliance Recap: Best Practices for Avoiding Legal Action

Health Fidelity recap of the risk adjustment legal compliance webinarLast week, Health Fidelity hosted a risk adjustment legal compliance webinar, “Risk Adjustment Compliance: Best Practices for Avoiding Legal Action.” I had the privilege of being joined by Health Fidelity VP of business development John Blevins as well as lawyers and healthcare legal experts Stephen Bittinger and John Lawrence of K&L Gates.

The event itself was a very educational experience, covering a wide variety of questions either asked through audience participation or direct explanation by our panel.

In the interest of spreading the incredibly timely and useful information, we’ve made two formats of the event available for download: A complete transcript, and an audio-recording for listening on the go.

Whichever format you chose, you’ll find discussion and answers to the following:

  • Does this uptick in DOJ intervention (covered here) represent a change in the standards or a change in enforcement?”
  • Are there common themes or risk capture practices linking these cases together?
  • What is the specific relationship between risk adjustment technology and client-side expertise on compliance enablement, prioritization, and the higher goal of risk adjustment programs?
  • What are the best practices around mitigating audit and compliance risk?
  • What circumstances suggest legal counsel be looped in?
  • What exactly is two-way review? Or QA? How do these support compliance?
  • What level of communication or transparency between providers and health plans is optimal for shared risk?
  • What is the difference between a systemic improvement and a self-corrective audit/action? What are the potential benefits?
  • What difference does timeliness have on submissions for providers and payers and audit risk?
  • What is the role of technology in a risk capture program?
  • What is the role of human experts? (e.g. autocoding as can be the case with FFS CPT codes).
  • Who all is liable in a Medicare FWA action?

The event was well-received and has become a great new resource in a highly active area of healthcare policy. We want to thank John and Stephen of K&L Gates for joining us and are proud to provide the recording as a resource for our current and future partners looking to ensure their own complete, accurate, and compliant risk adjustment program. If you have any questions or would like to learn more, contact us here.

Transcript  |  Recording