Becker's Healthcare March 3, 2023
Medicare Advantage plans are not required to identify when payments claims were denied, hindering fraud, waste and abuse investigations, according to a new report from HHS’ Office of Inspector General.
Unlike fee-for-service Medicare and Medicaid, Medicare Advantage plans do not have to indicate which claims are denied in encounter records. According to an OIG report published March 2, MA plans submit adjustment codes when they do not pay the full amount billed...
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