Since 2021, the OIG has issued 24 audit reports, and four of the reports have been published so far in 2023. These audits identified more than $400 million in overpayments, with approximately 72% of audited HCCs not validated / supported within the medical documentation The Office of
Read More →In-home care plays an important role within the US healthcare system. When done correctly, an in-home assessment provides a comprehensive overview of a patient’s health status, which is vital to identify potential health risks and can help ensure optimal outcomes for members who are unable to receive
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The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by the Centers for Medicare and Medicaid Services (CMS) to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member,
Read More →The Supreme Court recently denied a health plan’s petition related to the Centers for Medicare & Medicaid Service’s (CMS) Overpayment Rule, which requires Medicare Advantage (MA) organizations to return identified overpayments to CMS within 60 days. In short, this means that the Overpayment Rule remains in effect and
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