New Resource: HCC Tearsheet 2025. Access Now!
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New Resource: HCC Tearsheet 2025. Access Now!
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 impact of an audit. This service offers customizable analysis tailored to your needs, enabling you to focus on the OIG risk categories that are most critical to your organization.
We generate a detailed chase list that highlights the high-risk diagnosis codes within your claims data, allowing for proactive risk management.
Reports on key OIG audit categories can be run within our existing analytical SaaS offering, Episource Analyst. This gives you a centralized location for all your risk adjustment information, streamlining your workflow and enhancing decision-making.
Our team of experts is available to review your output and collaborate with you to develop customized remediation plans and tailored cleanup strategies, significantly mitigating the impact of potential audits.
Compliance Review’s analysis encompasses 100% of the logic outlined in the OIG Toolkit published in December 2023, providing you with complete confidence in your compliance posture and readiness for audits.
Avoid common practices that can lead to poor audit performance
Gain visibility into high-risk codes
Retract unsubstantiated diagnoses
Risk adjustment audit readiness
high-risk codes identified across our health plan clients
diagnoses found only once in a single source for these clients
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