With the increased scrutiny on Medicare Advantage Organizations (MAOs) given the news, it’s now more important than ever to have a solid risk adjustment compliance program.

Compliance programs are critical in the healthcare industry to ensure that all processes are carried out in accordance with applicable laws, regulations, and ethical standards.  With the final ruling on recent RADV repayments and final announcement on payment rates for CY2024,now is the time to become laser-focused on compliance.

Build a team of compliance champions

Having compliance champions that understand the rules and regulations that Medicare Advantage plans must adhere to will help inform the correct processes and policies that should be in place. Compliance officers for Medicare Advantage plans should include highly skilled, certified coders and auditors that have a deep understanding of CMS guidelines and regulatory knowledge to comply with external audits. Compliance champions play a pivotal role in ensuring the organization’s adherence to Medicare Advantage regulations and upholding the highest standards of integrity and ethics

Compliance champions ensure a stronger compliance culture.

The roles and responsibilities of compliance champions vary between organizations, but typically they are groups representing different areas and functions who operate as a link between the compliance team and the wider business. These responsibilities are performed in addition to their day-to-day roles.

They receive regular training from the compliance team on how to identify compliance issues and how to help their own teams report and mitigate issues that may arise. Champions can help the compliance team take a clear look at what is happening inside the organization at any one time and help identify gaps in knowledge to enable tailored training for different areas. In turn, they can act as ambassadors for the compliance team to spread messaging to different areas peer to peer and in a common language.

There is increasingly a mandate from regulators in many jurisdictions that businesses should have clear processes in place and accountability for how compliance issues are identified, managed, and escalated throughout the organization.

Typically in large organizations, the approach to incident reporting and accountability for compliance culture can be inconsistent, depending on the business area or function, and so a dedicated body of champions can significantly improve understanding and engagement with the company’s compliance program across frontline and mid-level positions.

This increased staff awareness and direct channels of contact between first-line and second-line functions can effectively create an early warning system to proactively understand risk themes across the business. Further, compliance champions can become the drivers and agents of the compliance culture, engaging people across the business to develop and live the desired corporate and ethical behaviors day to day.

Annova expertise in healthcare.

Annova works with the leading names in Healthcare in the US   with a no compromise focus on risk adjustment and compliance. We have around  20 years of experience and  operate with the highest standards complying with every regulatory and compliance laws. We also place a higher emphasis on accuracy. Accurate Coding is essential to ensure proper reimbursement and avoid claim denials. Healthcare providers must implement best practices and technology to optimize Revenue Cycle Management. With the right coding and billing practices, healthcare organizations can improve their Revenue Cycle Management, increase financial stability, and enhance patient care.  Accurate coding  address a host of critical issues   which include  the right reimbursement , uniform documentation, better patient safety and  significantly reduces  the risk of audits and penalties.