Medicare Advantage plans lose out in final RADV audit rule that ditches fee-for-service adjuster

The Centers for Medicare & Medicaid Services (CMS) unveiled a final rule Monday that details how it will handle Risk Adjustment Data Validation (RADV) audits to determine whether MA plans were overpaid by Medicare. The rule will apply the new methodology to plan contracts dating back to 2018 and will not adjust the overpayment amount based on a similar amount calculated by fee-for-service, known as the FFS adjuster.

“Thanks to...