Code Red: Aligning Risk Adjustment with CMS’s New Audit Mandate

Listen to the episode here.

For this week’s episode I’m bringing you something a little different, but of such importance that I had to share it with my Off the Record audience: The massive audit expansion of Medicare Advantage announced by CMS.

In case you missed it, CMS in May rocked the mid-revenue cycle industry with the unveiling of a startling mandate. It will hire 2000 medical coders, beef up its audit technology, and expand its current limited auditing scope from 60 Medicare Advantage Plans to some 550 plans nationwide in an attempt to check widespread allegations of HCC upcoding.

My colleague Jason Jobes has been closely following the news and presented this topic in June—the most attended webinar Norwood has ever hosted. This is a replay of that very well-received show. It covers:

• The evolving risk adjustment landscape and the rise of Medicare Advantage
• CMS’s broad and bold audit scope and strategy
• Best practice techniques to survive in risk adjustment and avoid potential risks

Jason refers to several slides during the presentation, which you don’t necessarily need, but if you’d like to follow along or see the exact references and data we’ve posted them to the Norwood website with a link in the show notes.

Enjoy the show!

Show notes and resources

• View the webinar slides here (free; requires registration)
• Read the full CMS audit announcement.