Managed Healthcare Executive January 31, 2023
The Risk Adjustment Data Validation (RADV) rule was finalized today. The new rule for governing how CMS audits Medicare Advantage plans for overpayment due to inflated risk adjustment could cost insurers billions of dollars.
Insurance trade groups blasted the risk adjustment rule for Medicare Advantage (MA) plans that CMS finalized today, signaling the start of what may be a prolonged legal battle over a rule that could cut payments to health insurers by billions and possibly slow the booming enrollment in MA plans.
“Our view remains unchanged: This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized,” said Matt Eyles, president and CEO of AHIP, the main trade association for the health insurance industry,...
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