One reason a comprehensive risk adjustment compliance program is critical is that identified overpayments may be recouped through risk adjustment data validation (RADV) audits. Given potential financial and reputational harm due to ICD-10 diagnosis code inaccuracies, health plans and risk-bearing provider groups are becoming increasingly proactive in
Read More →The Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would improve timely access to quality care for seniors under Medicare Advantage, unanimously passed the House of Representatives on September 14, 2022. The bill is now in the hands of the Senate. The act requires Medicare
Read More →With telehealth utilization at 38x what it was pre-pandemic, plan sponsors should address telehealth fraud as part of overall anti-fraud, waste and abuse plans The pandemic had a tremendous impact on healthcare delivery. Fee-for-service Medicare previously offered telehealth services on a limited basis—mostly to beneficiaries in rural
Read More →CMS released two time-sensitive HPMS memos on September 6, 2022: These changes impact Part D sponsors, Medicare Advantage and Part D sponsors, Medicare-Medicaid Plans, and Minnesota Senior Health Options plans for the upcoming Annual Enrollment Period (AEP). The Inflation Reduction Act of 2022 was signed into
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