Policy & Medicine March 18, 2023
On January 30, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final rule addressing how it will calculate and collect overpayments from Medicare Advantage (MA) plans arising from risk adjustment errors discovered through data validation audits. In the final rule, CMS announces that it will recover excess premiums paid to MA plans when it finds unsupported or inaccurate plan-submitted risk adjustment data. CMS will not only recover the specific premiums associated with a specific error but will also extrapolate a plan’s error rate across entire cohorts of beneficiaries, thereby magnifying the potential scope of recoveries.
What is Medicare Advantage Risk Adjustment Data Validation (RADV)?
Understanding RADV is important to appreciating the impact of this rule. Avalere has...
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