Deep expertise, flexible options
The Centers for Medicare & Medicaid Services (CMS), Department of Health & Human Services (HHS) and the Office of Inspector General (OIG) are required to audit diagnosis data submitted by health plans. Preparing for and undergoing an audit can be a massive task and we provide support every step of the way.
Audit services include CMS contract-level Risk Adjustment Data Validation (RADV) audits, CMS Improper Payment Measure (IPM) contract-level RADV audits and HHS-ACA RADV audits. Optum will:
- Analyze data and identify targeted medical records
- Retrieve, code and score records
- Prioritize records and submit to CMS or HHS
- Determine and collect attestations
- Report on audit results
We also offer OIG RADV support, including:
- Same services offered for CMS and CMS IPM contract-level RADV services
- Ability to customize services based on OIG audit requests
Optum also offers Claims Verification services that allows both prospective and retrospective charts to be evaluated for eligibility. Claims Verification is a process to:
- Review accuracy of hierarchical condition categories (HCC) submitted by claim data
- Compare to coding results from Optum Chart Review service
For clients performing a self-audit, we offer internal data validation review services.
Key benefits
Streamlined audit services for all your needs.
Leverage flexible options
Our solutions can be customized to meet your needs.
Engage dedicated support
We offer dedicated project management and a RADV audit team with extensive experience.
Get client-focused communication
We work with you and your team through the entire engagement.
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