Care Decoded
Care Decoded is the go-to podcast for clinicians, health plan leaders, and quality champions navigating the evolving world of risk adjustment, value-based care, and smarter documentation. Hosted by Inferscience, this show takes you inside the workflows, decisions, and technologies that turn clinical complexity into clarity. From demystifying HCCs and RAF scores to decoding CMS changes and exploring the impact of AI, we help you understand the data behind every diagnosis.
This show isn't about theory. It's about impact. Not about compliance. But confidence. Not about more clicks. But clarity at the point of care.
If you're building the future of care – one chart, one visit, one code at a time – Care Decoded is your ultimate guide.
Care Decoded
Building a Proactive RADV Audit Readiness Plan: People, Process, Technology, and More
Welcome to a brand new episode of Care Decoded! In this episode, host Mark McKeown is joined by renowned risk adjustment and coding expert Colleen Gianatasio to kick off a special two-part series diving into CMS’s heightened focus on RADV (Risk Adjustment Data Validation) audits. As Medicare Advantage plans face unprecedented scrutiny with CMS now pledging to audit all eligible contracts every year, the stakes have never been higher for compliance, documentation, and risk management.
Together, Mark and Colleen unravel the far-reaching impact of these changes across the healthcare industry, from the increased resource demands on health plans to building a culture of compliance and leveraging people, process, and technology for audit readiness. Drawing on her expertise, Colleen shares actionable strategies for integrating risk adjustment compliance into the fabric of organizations, explains the most common pitfalls in documentation and coding, and explores how AI and prospective tools can improve audit outcomes.
Whether you’re part of a health plan, provider group, or just interested in the world of healthcare compliance, this episode is packed with practical advice and insights on navigating the evolving landscape of RADV audits and value-based care. Tune in as we decode the latest industry challenges and get ready for the next episode, where we’ll dive deeper into the provider’s role in RADV success.
Disclaimer: The opinions expressed by any participants in this podcast recording are solely their own and do not represent any organization they worked for in the past or present.
Timestamps:
00:00 Medicare Advantage Under Scrutiny
06:18 Proactive RADV SWAT Strategy
07:18 Continuous Provider Communication Strategy
12:17 Top Coding Issues in Risk Adjustment
15:29 Optimizing Risk Adjustment with Data Analytics
19:34 Risk Adjustment Reporting Overhaul
23:09 Prospective Risk Beats Retro Adjustment
Podcast's Website - https://caredecoded.com/
Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/
Inferscience - https://www.inferscience.com/
Podcast Powered by TopHealth - https://tophealth.care/
“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”