ORLANDO, Fla. (PRWEB)
March 04, 2022

This partnership was formed when Advize and Boyce identified an industry-wide gap in effective, accessible Risk Adjustment Operations. The new ROA initiative is powered by healthcare experts and former Office of the Inspector General (OIG) officials. The team leverages decades of administrative and enforcement experience to mitigate risk and maintain the integrity of this specialized service. The RAIG will support legal audits and operate as a national auditor and advisory resource for risk adjustment programs and services.

“Today’s risk adjustment market is saturated with vendors who provide special services, from retrospective coding and data analytics to RADV and HRADV support. Historically, there have still been huge gaps in service. The industry needs a trusted third party to arbitrate and mediate for health plans, ACOs, risk adjustment vendors, and other organizations to fill in the gaps, audit coding work, investigate disparities, or provide essential support during DOJ or OIG investigations. Our RAIG is here to solve that problem,” said Eric Rubenstein, Director of Litigation and FWA Support at Advize Health.

The newly formed RAIG will help settle disparities between organizations with an informed and honest approach to what is appropriate for risk adjustment’s purpose while also being sensitive to DOJ and OIG concerns. It will offer audits for issuers, ACO’s, and risk adjustment vendors alike with a goal to ensure consistency in coding approach and practices. We will also serve as a reliable “tie-breaker” on coding disputes to provide compliant coding recommendations from general to highly complex cases. “Even the best risk adjustment vendor cannot also operate as your legal audit representative without a clear conflict of interest. This new group introduces a transparent and reliable resource to keep organizations compliant,” explained Eric Rubenstein.

This new service is not another entry designed to saturate an already bloated market, but rather to support those already utilizing third-party vendors, as well as the third-party vendors themselves. The RAIG is a supplement and added layer of protection to offer expert advice, compliance guidance, coding determinations, and other best practice recommendations.

“We believe this level of support has been long overdue and are excited to bring our RAIG nationally as a trusted resource in the risk adjustment space,” said Jeanmarie Loria, CEO of Advize Health.

Plans, ACO or RA vendors with inquiries or audit needs, please reach out to us at: info@advizehealth.com

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