Adopt the right strategy to best use the risk adjustment process
Plutus Health identifies errors that impact the risk scores. We analyze enrollment and demographic information to collate it with the source system. Our team reviews the HCCs and performs risk adjustment calculations to detect changes
Code verification
Verify the submitted diagnosis codes using medical record documentation to ensure accuracy and integrity
RADV audit preparation
Identify ICD-10 coding errors and confirm reported diagnoses. We review medical records to provide necessary suggestions
Comprehensive documentation
Compile detailed records supporting your claims and ensuring compliance with audit requirements
Accounts Receivables (AR) and Denial Management
Transparent and open communication with a dedicated point of contact to address any questions or concerns promptly
RADV audit services provided by Plutus Health
MA (Medicare Advantage) plans undergo RADV audits from CMS. Plutus Health uses the right strategy to help physicians and payers utilize risk adjustment submissions and help them to reach their maximum potential. We provide RADV audit services for the payers to check if the submitted DX codes can be validated with submitted documents. Plutus Health’s RADV audit support includes:
- Documentation vs coding gap analysis
- Determine the right records for CMS submissions
- Education program based on RADV audit needs
- Use of simulation methods for RADV audits
- Give audit analysis depending on the specific plan
- Examine and retrieve charts to detect all HCC codes
Plutus Health’s RADV audit service includes data retrieval & reporting, preparing documents, and medical record review
Schedule a call with an
RADV expert
Plutus Health’s comprehensive RADV audit services
Plutus Health aids payers to submit accurate Dx (Diagnosis) codes. We perform both retrospective and prospective audits. Our RADV auditors follow all the (Centers for Medicare & Medicaid Services) CMS risk adjustment data validation guidelines. Plutus Health’s RADV audit services include the following
Evaluate the existing data
Conduct simulated RADV Audits
Perform MRA/HCC coding with RADV validation
Review medical records to ensure compliance
Validate RADV documentation requirements
Generate plan-specific audit analysis reports
Identify areas of concern & propose corresponding solutions
Our happy clients
I am incredibly impressed with Plutus Health’s RADV audit services. Their accuracy rate was exceptional, ensuring reliable risk adjustment payments. The coding accuracy and timely completion were remarkable. Plutus Health’s experts cooperated excellently with our providers, making the process smooth. Their cost-effectiveness was a bonus. Working with Plutus Health has significantly improved our risk adjustment process and financial outcomes.
