Healthcare audits can occur all year round, yet there is a notable high season for requests every spring. Practices are already dealing with everyday administrative responsibilities related to staff training, digital health information management, EMR systems and the like. Audit requests can hit without much warning, so we want to help you stay informed on exactly what you need to know and how to best manage those processes to remain both effective and compliant.
Typically, HEDIS audits are at their height from January to May, with Medicare Risk Adjustment audits hitting from May to the end of the year. Here’s how we break it down:
HEDIS Audits (~15% of audits) The Healthcare Effectiveness Data and Information Set audit evaluates the quality of health plans. The audit is separated into two parts, the first of which measures a plan’s information systems abilities, and the second is related to HEDIS compliance.
Medicare Risk Adjustment audits (~85% of audits) The purpose of the risk adjustment system is to sufficiently cover the costs of providing covered benefits for Medicare Advantage enrollees, including those with complex conditions. The Medicare Advantage risk adjustment system assigns a value or “risk score” to each beneficiary according to age, gender, health status, etc. The risk score reflects the person’s predicted health costs compared to those of an average beneficiary.
We have completed over a million audits at HealthMark – and we have never missed a deadline. Weekly meetings with vendors, a clear understanding of authorized access, and a secure platform help us to manage these requests appropriately. Here’s how it looks:
It is important that you understand exactly how your audits are completed – what your partner or vendor will have access to, expected timeline for completion, etc. We process audits for 100% of our current clients throughout all of audit season. We encourage you to ask about HealthMark Group if you ever talk to an audit retrieval vendor – we are proud to help organizations become more efficient, compliant, and accurate when it comes to handling audit requests.
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For any questions related to audit season and how we may be able to help partner with you to manage requests more effectively, please contact us at firstname.lastname@example.org.