CMS finalizes rule on Medicare Advantage risk adjustment data validation

The Centers for Medicare & Medicaid Services yesterday finalized technical details regarding the Medicare Advantage Risk Adjustment Data Validation program, which the agency uses to recover improper risk adjustment payments from MA plans when the medical diagnoses submitted for payment are not supported in the beneficiary’s medical record. Under the final rule, CMS will extrapolate RADV audit findings beginning with payment year 2018, and require MA organizations to remit improper payments identified during RADV audits in a certain manner. The rule also finalizes a policy to remove the Fee-for-Service adjustment factor previously applied in RADV audits.