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
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  • Lauren Flynn Kelly

    Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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