Risk Adjustment Data Validation (RADV)

On July 17, 2008, CMS announced a pilot program to more extensively audit a select group of Medicare Advantage health plans. RAFs (Risk Adjustment Factors) that were not supported in the medical records were adjusted at the plan level, rather than at the beneficiary level as in the past. This extrapolation change made the negative financial implication a critical consideration.



With the RADV pilot completed, CMS has begun conducting further RADV audits to determine whether differences in coding between MA plans and Fee-For-Service providers are the result of coding patterns or of underlying beneficiary health status. Additionally, CMS has expanded its RADV audits to randomly selected plans to generate statistically valid plan level payment error estimates based on 2007 payments.



STORAN have developed an innovative, refined process to provide a broader solution with the goal of optimizing HCC validation within a very constrained time frame. Because it is not enough to simply identify revenue opportunity, we assist our clients with the complicated and resource intensive interventions that follow Storan Technologies Inc., offers wide range of Medicare Risk Management services to Medicare Advantage Plans around United States. Storan Technologies Medicare Risk Management product is known as Merlin Medicare Risk Adjustment. Medicare Advantage Plans utilize Merlin Medicare Risk Adjustment for:

• Comprehensive in depth financial analysis like revenue forecasting, delayed and lost revenue and revenue history at member and plan level
• Identify charts and physician for retrospective audits using a comprehensive suspecting engine based pharmacy, missing HCCs and ICD9 based statistical rules
• Detailed chart history of each individual with details like ICD9, Date of Service, Part C HCC, Part D HCC, Factor Value and Provider who diagnosed it with a single click
• Comprehensive Retrospective audit tools available to Schedule, Track and Manage the complete process of retrospective audit
• Reports to monitor Retrospective audit and its financial impacts for Plan
• Comprehensive Provider Education Reports
• Automated RAPS generation process aided with de-duplication, identification and correction of RAPS errors
• Fully encrypted and secure file sharing and data transfer
• All reports are easily exportable to Excel and PDF

All these services and many more are available in Merlin Medicare Risk Adjustment in an encryption and security HIPPA compliant user friendly web interface which does not require any installation or configuration at your end and its available on a wide range of plat forms like you can access it using any web browser FireFox, Chrome, Safari or Internet Explorer from your Windows or MAC machine or even from your iPhone. Merlin Risk Adjustment is using HIPPA compliant an encryption and security

Merlin Risk Adjustment is also available in desktop version for retrospective audits. It can work without internet connectivity. It only requires internet connectivity for synchronization with Storan secure data servers in order to retrieve and post retrospective audit data

Call us today at 636.477.7701 option 1 to find out how you can implement a HCC Management system in as little as four days or for a live demo of Merlin Risk Adjustment