Retrospective Risk Adjustment


With CMS tightening risk adjustment payments to plans and now performing RADV Audits, what’s a reasonable approach to preparing for these audits while at the same time ensuring our Medicare Advantage Plan is receiving CMS payments?

At AE & Associates, our Retrospective Chart Review includes all the processes needed to implement a successful retrospective service where the plan is reimbursed at a higher rate. Our services encompasses the retrieval of medical records of members who are most likely to have incomplete, inaccurate, or missing codes, retrieving and scanning charts at the provider office, and preparing the data file for the health plan for submission to CMS.