Health Payer Intelligence August 22, 2023
Ahead of RADV audits, Medicare Advantage plans must internally review charts, invest in compliance programs, and monitor coding vendors.
Increasing internal audits and implementing additional coding oversight can benefit Medicare Advantage organizations as they manage new auditing regulations, Melissa James, senior consultant at Wolters Kluwer, told HealthPayerIntelligence.
The Medicare Advantage Risk Adjustment Data Validation (RADV) final rule changed how CMS determines payment adjustments for Medicare Advantage plans. Medicare Advantage organizations must prepare accordingly to successfully navigate these audit changes.
The RADV process aims to reduce Medicare Advantage overpayments by auditing plans to confirm their coding activities accurately reflect beneficiaries’ health statuses. Major changes in the RADV final rule revolved around the fee-for-service (FFS) adjuster and extrapolation, sparking some...
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