Welcome back to Care Decoded! In this episode, we dive into the second part of our RADV miniseries, shifting focus from what RADV is, to the crucial role of frontline providers in ensuring accurate, defensible documentation as part of everyday care. Host Mark McKeown is joined once again by Colleen Gianatasio, an expert in risk adjustment and value-based care with over 20 years of experience.

Together, they explore why provider documentation is the foundation for RADV compliance, the biggest barriers clinicians face in meeting documentation requirements, and how the right technology, like AI-driven coding support, can help bridge the gap between compliance demands and real-world clinical practice.

You’ll hear practical strategies for reducing provider burnout, cultivating a culture of accuracy, and fostering effective collaboration between plans and providers, ultimately leading to better patient outcomes and a stronger, more resilient healthcare system. Let’s keep decoding care together!

Disclaimer: The opinions expressed by any participants in this podcast recording are solely their own and do not represent any organization they worked for in the past or present.

Timestamps:

00:00 "RAD V: Provider Role & Technology"

04:08 Coding vs. Clinical Guidelines Conflict

07:08 Advancing Patient Care Through Coding

11:47 Optimizing Patient-Provider Time

14:39 Celebrate Success, Share Best Practices

17:00 Concluding RAD V Miniseries

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Welcome to a brand new episode of Care Decoded! In this episode, host Mark McKeown is joined by renowned risk adjustment and coding expert Colleen Gianatasio to kick off a special two-part series diving into CMS’s heightened focus on RADV (Risk Adjustment Data Validation) audits. As Medicare Advantage plans face unprecedented scrutiny with CMS now pledging to audit all eligible contracts every year, the stakes have never been higher for compliance, documentation, and risk management.

Together, Mark and Colleen unravel the far-reaching impact of these changes across the healthcare industry, from the increased resource demands on health plans to building a culture of compliance and leveraging people, process, and technology for audit readiness. Drawing on her expertise, Colleen shares actionable strategies for integrating risk adjustment compliance into the fabric of organizations, explains the most common pitfalls in documentation and coding, and explores how AI and prospective tools can improve audit outcomes.

Whether you’re part of a health plan, provider group, or just interested in the world of healthcare compliance, this episode is packed with practical advice and insights on navigating the evolving landscape of RADV audits and value-based care. Tune in as we decode the latest industry challenges and get ready for the next episode, where we’ll dive deeper into the provider’s role in RADV success.

Disclaimer: The opinions expressed by any participants in this podcast recording are solely their own and do not represent any organization they worked for in the past or present.

Timestamps:

00:00 Medicare Advantage Under Scrutiny

06:18 Proactive RADV SWAT Strategy

07:18 Continuous Provider Communication Strategy

12:17 Top Coding Issues in Risk Adjustment

15:29 Optimizing Risk Adjustment with Data Analytics

19:34 Risk Adjustment Reporting Overhaul

23:09 Prospective Risk Beats Retro Adjustment

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Welcome to another episode of Care Decoded, the podcast where we break down the most pressing issues in modern healthcare. In today’s episode, host Michael Lesnik, VP of Provider Sales at Inferscience, sits down with Dr. Sunil Nihalani, CEO of Inferscience and a practicing physician, to unravel the complexities of “care gaps”, those critical yet often overlooked opportunities to improve patient care and outcomes.

Drawing on over fifteen years of experience in healthcare IT and value-based care, Michael and Dr. Nihalani dive deep into why care gaps persist, the challenges providers face in closing them, and why it’s about more than just checking a box on a metric sheet. From the realities of data accuracy and insurance hurdles to the vital importance of patient communication and trust, this episode explores the human side of healthcare quality. You'll also hear firsthand strategies for closing care gaps effectively, how technology, including AI, is changing the landscape, and why these efforts matter for both health equity and patient relationships.

Whether you’re a healthcare provider, a member of a clinical team, or simply passionate about better patient care, this conversation offers practical insights and fresh ideas to help you and your organization “decode” the intricacies of care gap closure.

Let’s get started!

Timestamps:

00:00 "Optimizing Patient Care Opportunities"

05:17 Patient Data and Trust Issues

08:07 Patient Education on Health Screenings

13:32 "Small Practice, High Ratings Success"

14:18 AI's Role in Healthcare Gaps

18:57 AI-Powered Care Gap Detection

23:11 "Closing Care Gaps: A Holistic Approach"

23:50 "Decoding Care Together"

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”