Retrospective Compliance Cleanup
A Roadmap for Remediating Risk
Leverage our Retrospective Compliance Cleanup service to surface high-risk codes
Revamp Your Compliance Analytics & Minimize Audit Risk
CMS, OIG, and the DOJ are cracking down on non-compliant risk adjustment methods. These agencies are conducting more audits of health plans every year and investing in analytical resources to speed up these audits. That’s why we developed the Retrospective Compliance Cleanup. To identify the diagnosis codes in a RADV audit that are most likely to be non-compliant, the Retrospective Compliance Cleanup combines analytics, natural language processing, and deep subject matter expertise.
OIG audits continue to ramp up as scrutiny increases over the past several years.
Deploy robust algorithmic, NLP,
and human review.
Key Features
Effortlessly import coding outputs and claims data with guidance from our experts.
Run Detailed Reports
The Retrospective Compliance Cleanup provides reports on all high-risk diagnosis codes, pinpointing non-compliant criteria and highlighting codes that present additional compliance risk. We even include specifics on total non-compliant HCCs, exact HCC codes, and their sources.
Follow-Up Session with an Expert
Receive an in-depth discussion with Episource to explain your results and develop a strategic roadmap for remediating risk.
Historic Dates of Service Analysis
Review historic codes and claims to verify compliance and gain confidence in your organization’s performance — for any year that OIG chooses to audit.
Compliance & Risk Mitigation
Address HCC coding compliance risks with a solution committed to staying up-to-date with evolving regulations. The Retrospective Compliance Cleanup includes the logic included in OIG’s toolkit designed for Medicare Advantage plans to decrease improper payments.
Access Additional Resources
To see how Retrospective Compliance Cleanup can help your organization reduce risk with robust analytics and expert teams, access our resources below.