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With the number of audits being conducted by the Office of the Inspector General (OIG) ramping up over the past several years, it’s imperative that health plans have a strategy in place to ensure their submissions are accurate and well-documented.
With Compliance Review, Episource combines advanced analytics, NLP technology, and subject matter expertise to surface and resolve compliance risk, thereby reducing the risk of audit. Within this service, we offer two types of risk adjustment compliance solutions, Compliance Pack and the Retrospective Compliance Cleanup, that can either be purchased separately or bundled together depending on your organization’s needs.
Compliance Pack is a report that clients can continually generate from Episource Analyst, our risk adjustment analytics platform.
Episource Analyst continually reviews real-time data for medical claims and coding outputs that have a high probability of being chosen for an audit. Then, we surface four key diagnosis categories that pose compliance risk and outline these in a report:
With the Retrospective Compliance Cleanup, we don’t just flag codes that present a high audit risk; we actually clean them up with tailored strategies.
We start by analyzing all claims, coding, and pharmaceutical data, replicating OIG’s targeted audit analytics in addition to our own proprietary algorithms to isolate codes that pose high audit risk. With this information, we provide:
Avoid common practices that can lead to audit
Gain visibility into high-risk codes
Retract unsubstantiated diagnoses
Risk adjustment audit prevention
high-risk codes identified across our health plan clients
diagnoses found only once in a single source for these clients
500 W. 190th Street, Suite #400 Gardena, CA, 90248 USA