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 →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 →
