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Episource Announces New Solution To Reduce Compliance Risk With Targeted Interventions

Retrospective Compliance Cleanup: Reduce Compliance Risk With Targeted Interventions
December 15, 2022

Los Angeles, Calif., December 16, 2022 – Episource, one of the largest services and technology companies for risk adjustment and quality, today announces the launch of its innovative Retrospective Compliance Cleanup. By partnering with Episource on this solution, Medicare Advantage health plans and provider groups will be able to combine advanced compliance analytics, natural language processing (NLP) technology, and deep subject-matter expertise to surface and resolve their compliance risk.

Today, health organizations nationwide are facing tremendous pressure by governmental bodies like the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) to ensure proper documentation of every submitted diagnosis.

The Retrospective Compliance Cleanup doesn’t just flag codes that present high Risk Adjustment Data Validation (RADV) or OIG audit risk; it incorporates powerful technology and coder expertise to audit each of these instances in a health plan or provider group’s encounter data.

“At Episource, 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,” says William Schweitzer, Episource’s Associate of Platform Strategy & Solutions. “With this information, we provide a comprehensive report of each code, why it was flagged, and the relevant encounter data.”

Additionally, the Retrospective Compliance Cleanup creates a tailored roadmap for remediating risk, which may include second-level review, retrieval, and coding. What really adds value to the solution is that clients also receive a live session with an Episource expert to review insights and plan interventions.

Beyond delivering next-level unsubstantiated code deletion, Episource performs an NLP-powered second-level review to capture codes that were missed in initial coding, potentially offsetting the net impact.

“In this regulatory landscape, the need for proactive review of and oversight into coding and submission processes is more critical than ever,” says Erik Simonsen, Episource’s Chief Operating Officer. “Episource can serve as a strategic partner to MA health plans and provider groups who lack the resources needed to stay on top and ahead of compliance policy changes.”

The Retrospective Compliance Cleanup offering joins Episource’s full suite of risk adjustment products and solutions, which also includes: Analyst, Final Check, Coder, and more.


About Episource

Episource reinvents risk adjustment program management across healthcare organizations with an integrated platform. We empower the most recognizable names in healthcare with end-to-end risk adjustment solutions. From risk adjustment analytics, retrospective chart reviews, in-home assessments, encounter submissions, and quality reporting, Episource simplifies healthcare with elegance and innovation.

Media Contact:

Maia Lee