Healthcare Finance News November 24, 2020
Risk adjustment data validation ensures payment integrity and accuracy and it affects what plans are paid.
The Centers for Medicare and Medicaid Services today released the final rule to change the methodology for the U.S. Department of Health and Human Services’ risk adjustment data validation (HHS-RADV) program.
The program, which has operated since the 2017 benefit year, provides payments to insurers that cover high-risk, high-cost individuals. The payments are funded through charges to insurers that cover lower-risk enrollees. Insurers submit their own data, so HHS-RADV works to verify that the data is accurate and complete based on the risks of their members.
In CMS’s final rule, the error rate calculation and the application of HHS-RADV results have been updated.
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