News Briefs: CMS Kicks Off Payment Year 2018 RADV Audits With 60 Chosen MA Contracts
-
Nov 21, 2024
CMS has selected 60 Medicare Advantage contracts for risk adjustment data validation (RADV) audits to confirm that risk adjusted payments issued to MA organizations in 2018 were based on accurate medical diagnoses. According to a frequently asked questions document posted on Nov. 15, CMS said it has notified the CEOs and compliance officers of the MA contracts up for audit and expects to begin issuing the payment year 2018 findings in “mid-calendar year 2026, including on how the overpayments will be collected as part of the audit.” MAOs will have an opportunity to appeal the results. To verify the accuracy of payments made in 2018, which reflect care delivered in 2017, CMS will select samples of enrollees within the audited contracts and request medical records for them. In a rule finalizing its plans to recover amounts based on extrapolation, CMS estimated it will recover $479 million in overpayments from 2018. Read more
© 2024 MMIT
The Latest
Meet Our Reporters
Meet Our Reporters
GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND
Sign up for publications to get unmatched business intelligence delivered to your inbox.