Both the Center for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) have voiced concerns regarding risk-adjusted revenue integrity.
A recent OIG report found that some Medicare Advantage Organizations (MAOs) may leverage chart reviews and Health Risk Assessments to potentially exaggerate the negative health status of members. Because program revenue is risk adjusted, these representations have likely resulted in excess and inappropriate revenue for the MAOs.
FRG offers its newest reporting service, the Revenue Audit and Monitoring Program (RAMP™) service. The RAMP™ service provides member-level analysis for each payment year and serves to document the supporting detail from encounter and RAPS records side by side with the CMS.
By providing this level of analysis, FRG helps MAOs ensure the appropriateness of their risk-adjusted revenue and address weaknesses in their accruals.