Lexology January 30, 2024
The U.S. Department of Health and Human Services (“HHS”), through the Centers for Medicare & Medicaid Services (“CMS”), issued a final rule early last year which, among other things, implemented stricter audits of Medicare Advantage plans, by striking the fee-for-service adjuster from risk adjustment data validation audits. The rule implements changes to the Medicare Advantage Risk Adjustment Data Validation (“RADV”) program, which CMS uses to recover improper risk adjustment payments made to Medicare Advantage (“MA”) plans.
CMS stated in the corresponding Fact Sheet that the RADV final rule will help CMS to protect the MA program by “addressing instances where Medicare paid Medicare Advantage Organizations (“MAOs”) more than they otherwise should have received because the medical diagnoses...
Today's Sponsors
Today's Sponsor