AJMC September 25, 2023
Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care for members.
Medicare Advantage organizations (MAOs) are facing new government regulations that are motivating them to take a close look at their risk adjustment programs and policies. In January 2023, CMS released its Risk Adjustment Data Validation (RADV) final rule, which includes changes that will result in the government recouping an estimated $4.7 billion through audits. Also this year, the Medicare Advantage final rule was released, and while it was more lenient for MAOs in terms of the compliance timeline, the urgency among plans to shore up risk adjustment practices and ensure accurate...
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