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.

Related News Articles

Headline
AHA May 17 shared with the Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations its concern that some MA plans inappropriately…
Headline
The Centers for Medicare & Medicaid Services yesterday released additional information on the Medicare Advantage Value-Based Insurance Design Model…
Headline
The Centers for Medicare & Medicaid Services April 5 released a final rule that would increase oversight of Medicare Advantage plans and better align…
Headline
Headline
The Centers for Medicare & Medicaid Services today finalized proposed changes to Medicare Advantage plan capitation rates and Part C and Part D payment…
Headline
The Centers for Medicare & Medicaid Services plans to extend the Medicare Advantage Value-Based Insurance Design Model for an additional five years,…