McKnight's February 3, 2023
Kimberly Marselas

Federal efforts to rein in Medicare Advantage spending and recoup payments awarded for improper diagnoses will likely lead to even more financial pressure on nursing homes that serve plan beneficiaries, according to experts who monitor managed care.

The latest blow for insurers came Wednesday evening, when the Centers for Medicare & Medicaid Services announced its proposed payment notice for 2024. It would effectively cut average pay to MA plans by 2.3% next year when factoring in coding and data conversions.

Just two days earlier, CMS announced its new audit approach, which is expected to allow the agency to claw back about $479 million annually from overpayments starting with calendar year 2018. Those can’t be collected until new audits are conducted,...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Post-Acute Care, Provider
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