Medicare Advantage RADV Final Rule Changes: With an Expected Audit Recovery of Nearly $5B in Next 10 Years, Will Your Plan Face an Audit?

The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by CMS to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member, as determined by the Hierarchical Condition Category

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RADAR on Medicare Advantage | With Final RADV Rule Out, MAOs Are Advised to Clean Up Risk Adjustment Practices

Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified

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2024 Proposed Rule Changes: Medicare Advantage Agent/Broker Compliance Oversight | Medicare Advantage and ACA Provider Directories & Contracting | ACA HHS Risk Adjustment Data Validation

CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the

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Risk Adjustment Compliance and ICD-10 Diagnosis Code Accuracy: Three Areas of Concern Identified by the OIG 

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

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