Becker's Healthcare January 31, 2023
Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create higher premiums and fail to target fraud. Others say the new rule, which eliminates the fee-for-service adjuster, doesn’t go far enough.
CMS published its final rule on Medicare Advantage risk adjustment data validation audits Jan. 30. The new standards mean MA plans could be on the hook for billions in payments to the federal government, but the rule will only be applied to audits for contracts from 2018 on. Earlier versions of the proposed rule indicated the agency would apply the auditing standards as far back as 2011.
Here’s what seven industry leaders and officials had to say about the ruling.
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