REVENUE CYCLE MANAGEMENT
Risk Adjustment / Version 28
Protecting Revenue and Improving Care Quality
Version 28 LLC is a collaboration of risk adjustment experts, including physicians, auditors, coders, and technology professionals, all dedicated to mitigating the impact of Version 28 (V28) on health plans, at-risk providers, and any entity affected by risk adjustment revenue. Our team’s multidisciplinary approach ensures that every aspect of the risk adjustment process is covered, from accurate coding and compliance to advanced technological solutions.
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By working closely with organizations, we help mitigate financial risks and potential revenue losses caused by Version 28. Our proven strategies provide a clear blueprint for improving care quality while safeguarding revenue streams. Whether it's enhancing clinical documentation or streamlining the coding and auditing processes, Version 28 LLC delivers tailored solutions that not only protect your revenue but also elevate patient care and operational efficiency.
Fraud, Waste, and Abuse
Protecting Providers and Health Plans from Legal and Financial Risk
Chelsea Management Group (CMG) offers expert services in fraud, waste, and abuse (FWA) defense, helping physicians, managed service organizations (MSOs), and health plans navigate the complex landscape of audits, recovery demands, and the False Claims Act. With over 20 years of experience, CMG provides specialized defense against recovery letters from Unified Program Integrity Contractors (UPIC) and CMS audits, including high-risk cases like amniotic fluid joint injection recoveries.
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Our team includes seasoned experts in Medicare risk adjustment documentation, coding audits, and electronic medical record (EMR) reviews. We verify the accuracy of medical records using audit logs and metadata, demonstrating compliance and defending against allegations of tampering or fraud. CMG’s deep knowledge of clinical governance and compliance ensures that providers and health plans remain secure in their documentation and operational processes.
From defense against Federal False Claims Act cases to managing FWA audits for major health plans like United, Anthem, and Humana, CMG’s proven track record delivers results. We provide comprehensive support, including physician education on documentation and coding, risk adjustment solutions, and managed care oversight, ensuring that your organization meets regulatory standards while mitigating financial risk.
Expert Witness
Expert Witness and Consultant Services for Fraud, Waste, and Abuse
Chelsea Management Group (CMG) offers expert witness services with over 50 years of combined experience in defending physicians, managed service organizations (MSOs), and health plans against allegations of fraud, waste, and abuse (FWA), including False Claims Act cases. Our team provides comprehensive support in Medicare risk adjustment documentation and coding audits, offering defense against both unintentional errors and intentional upcoding claims.
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Our expertise extends to the review and verification of Electronic Medical Records (EMRs), utilizing audit logs and metadata to ensure the accuracy of medical records. We help demonstrate objective evidence in cases involving tampering claims or documentation errors. CMG also provides managed care support, including in-home physician services, telehealth, and clinical governance, ensuring compliance and oversight across a range of healthcare settings.
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With vast experience as clinical governance and compliance leads at health plans and physician practices, CMG's expert witness services cover areas like physician documentation, risk adjustment, coding accuracy, and quality programs. We work closely with legal teams and healthcare organizations to offer expert guidance and defend against FWA claims, safeguarding your operations and reputation.
Additional Services We Offer
CLINICAL SERVICES
Telehealth Transformation:
Expand your reach and improve care with optimized telehealth services.
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Addressing Health Inequities:
We help you integrate Social Determinants of Health into your care models.
In-Home Care Expertise:
Enhance care delivery with our in-home primary care solutions.