MedCity News January 31, 2023
The final rule calls for stricter audits on Medicare Advantage plans. AHIP president and CEO Matt Eyles referred to the rule as “unlawful and fatally flawed.”
Insurers are pushing back after the Centers for Medicare & Medicaid Services (CMS) issued its final rule on the Medicare Advantage Risk Adjustment Data Validation (RADV) program Monday. The rule will lead to stricter audits on Medicare Advantage plans.
Currently, CMS regulators have been reviewing a small group of beneficiaries’ medical records and comparing them to the patients’ diagnoses to verify that MA plans were billed correctly. Medical records don’t always support patient diagnoses reported by MA organizations, leading to “billions of dollars in overpayments and increased costs to the Medicare program,” CMS said....
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