April 27, 2023 | 1:30 EST | 1 Hour
A RISE Association Webinar in Partnership with Centauri Health Solutions
We are continuing the interactive discussion we started at RISE National 2023 about data hygiene and the importance of performing a holistic assessment of data and revenue leakage as part of an overall data governance strategy for risk adjustment using a “leaky hose” metaphor, with the claims universe being the “faucet” end of the hose and risk adjustment operations being the “nozzle” end of the hose. Our discussion included many of the typical reasons for the holes in the hose that cause risk adjustment data and revenue leakage, and an overview of how to address them. We also discussed the need for both concurrent and retrospective data governance strategies to manage leaks, and how to empower providers related to non-clinical improvement activities designed to prevent and address leaks.
The Golden Questions were revealed as we concluded our discussion, and so now we focus on how one health plan answered the Golden Questions:
The focus of this webinar will be a case study of how one health plan undertook this assessment of their risk adjustment “garden” and translated their leakage analysis into action, and the result – the “harvest”. Assessments such as these are more important than ever given the recent RADV announcement, the MA Advance Notice, and even the OIG presentation at RISE National 2023 to ensure your data governance strategy addresses the Golden Questions, and also the question of “Why are our claim costs so high but our RAF is so low?”
Topics at a Glance:
This webinar is designed to specifically benefit those with responsibilities in the following areas: