AHIMA May 22, 2023
This article is published in collaboration with Omega Healthcare.
After a four-year long delay, the long-awaited Risk Adjustment Data Validation (RADV) final rule is now in place. The purpose of the rule is to improve payment oversight of Medicare Advantage (MA) plans, ensure accurate payment for providers, and improve members’ access to benefits.
Why the RADV Final Rule is Significant
A total of 90 federal billing audits from 2011 through 2013 uncovered substantial overcharges and payment errors to MA senior plans, along with approximately $12 million in non-extrapolated overpayments.
Thirty million people depend on MA plans to receive their Medicare benefits. The final rule helps ensure appropriate steps are taken so that the program is fully funded while at the...
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