Healthcare Finance News January 30, 2023
AHIP says the rule remains “unlawful” and “fatally flawed.”
The Centers for Medicare and Medicaid Services has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations.
Studies and audits done separately by CMS and the Health and Human Services Office of Inspector General have shown that Medicare Advantage enrollees’ medical records do not always support the diagnoses reported by MAOs, which leads to billions of dollars in overpayments to plans and increased costs to the Medicare program as well as taxpayers, CMS said.
Despite this, no risk adjustment over payments have been collected from MAOs since payment year 2007, CMS said.
The Risk Adjustment Data Validation final rule, released on Monday, holds...
Today's Sponsors
Today's Sponsor