Navigating the HHS-RADV IVA: A strategic guide for selecting a partner

Since its inception in the 2016 benefit year, the HHS-RADV Initial Validation Audit (IVA) has stood out as a critical process for ACA plans. RADV-IVA scores are about more than individual performance. Results are compared to other plans in the state, with higher performers receiving higher proportions of payments and laggards risking reduced funding.

This makes IVA compliance a financial balancing act where performance relative to others can make or break an ACA plan’s bottom line. With so much at stake, IVA vendor selection becomes a strategic opportunity to optimize financial performance and improve patient care.

Considerations for vendor selection

When choosing an IVA vendor, healthcare plans should look beyond surface-level capabilities. The most successful partnerships are built on a foundation of comprehensive service offerings, technical excellence, and a collaborative approach. In a recent webinar, Reveleer surveyed payers who reported consistent challenges with their certified auditors and IVA processes, including:

• Delayed medical record retrieval
• Poor coding quality
• Inadequate reporting dashboards
• Limited collaboration

As value-based care grows, organizations are facing unprecedented challenges in data management and risk adjustment accuracy. Health plans need their certified IVA vendor to address these pain points directly to make the audit process as seamless as possible.

Technical capabilities matter‍

Reveleer has been at the forefront of this evolution, developing a comprehensive, transparent platform that goes beyond traditional audit methods. Reveleer's platform processes an impressive 96,000 pages per hour, totaling more than 214 million medical record pages annually. This scale demonstrates the importance of robust technological infrastructure in modern IVA services.

Coding quality and accuracy‍

The heart of any IVA service lies in its coding accuracy. Top-tier vendors maintain rigorous standards to ensure excellence in this critical area. These standards typically include maintaining a 95% accuracy rate; employing credentialed, onshore coders; ensuring year-over-year coder retention; and adhering strictly to IVA protocols.

The importance of transparency‍

True transparency in IVA services goes far beyond simple reporting. It means providing real-time access to various aspects of the audit process. This includes detailed retrieval processes, comprehensive coding workflows, transparent communication logs, and actionable dashboards.

Communication and support model‍

An exceptional IVA vendor provides more than just a service – they become a strategic partner. This partnership is built on a robust communication and support model. Key elements of this model include dedicated customer success managers, regular standing meetings, comprehensive work plans, executive oversight, and continuous improvement processes.

Future-proofing your IVA strategy‍

As healthcare continues to evolve, it's crucial to select an IVA vendor with an eye on the future. Look for vendors that demonstrate continuous technological innovation and adaptability to regulatory changes. Additionally, prioritize those offering scalable solutions and showing a commitment to improving healthcare outcomes.

Selecting the right IVA vendor is a strategic decision that can impact your organization's efficiency and financial performance. By focusing on comprehensive capabilities, technical excellence, and transparent processes, healthcare plans can transform their approach to IVA compliance.

Pro tip: Take your time in the selection process. Request detailed demonstrations, speak with current clients, and assess each vendor's ability to meet your specific organizational needs.

The future of value-based care belongs to those who can effectively leverage technology, data, and strategic partnerships. A certified auditor for HHS-RADV IVA is not just a vendor – they're a critical partner. Request a demo today to see how Reveleer can partner with you to achieve a successful submission.

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