Risk Adjustment IVA Important Information

Oct. 18, 2019

The height of Affordable Care Act Risk Adjustment Data Validation - Initial Validation Audit (ACA-RADV IVA) season is here. As a result, your office may have received requests for medical records on behalf of Blue Cross and Blue Shield of Texas (BCBSTX).

For some practitioners, the demands of fulfilling these medical records requests can be overwhelming as well as being a disruption for physicians and office staff.

Lessen the Burden

BCBSTX would like to recommend some best practices such as conducting internal audits and implementing checks which could reduce inefficiencies during the ACA-RADV IVA audit. These recommendations could increase promptness in receipt of medical records, as well as identify opportunities for billing and coding improvements.

The following best practices could potentially lessen the burden presented by additional requests and statements of attestation:

  • Medical Records Requests – Be sure to send all medical records requested for the audit calendar year, ensuring the following documents are included for all dates of service with the providers timely signature.
    • Physician's Progress Notes
    • Discharge Summaries
    • Operative Reports
    • A&P Notes
  • Review provider signature authentication before submission. All medical record entries must be complete and must be authenticated by the physician or practitioner who was responsible for ordering, providing or evaluating the service furnished. Acceptable physician/practitioner authentication comes in the form of handwritten signatures or electronic signatures and would include the following requirements:
    • Legible typed or printed name with handwritten signature
    • Provider's Credentials
    • Date of authentication

IMPORTANT NOTE: Attestations will be required if the above-mentioned requirements are not included on the patient's medical records or if the physician's signature on the medical record is more than 180 days after the actual date of service.

If you have any questions, please contact your Network Management Representative, email the BCBSTX IVA team or contact the BCBSTX IVA Hotline at 1-972-766-2838. For additional resources please visit CMS or the BCBSTX provider website.