Risk Adjustment

8 Best Practices for In-Home Assessments: How to Ensure Quality Patient Care & Compliance with Medicare Regulations

On March 29, 2023 / Risk Adjustment

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

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

On February 17, 2023 / Data Audit, Risk Adjustment

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,

Overpayment Rule Stands: Review Your Plan’s Processes and Procedures Now to Avoid False Claims Act Liability

On July 6, 2022 / Risk Adjustment

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

8 Best Practices for In-Home Assessments: How to Ensure Quality Patient Care & Compliance with Medicare Regulations

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

Overpayment Rule Stands: Review Your Plan’s Processes and Procedures Now to Avoid False Claims Act Liability

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