{"id":497,"date":"2023-01-31T18:03:24","date_gmt":"2023-01-31T18:03:24","guid":{"rendered":"https:\/\/wheretobuymarijuanaseeds.com\/cms-finalizes-risk-adjustment-policies-to-combat-medicare-advantage-overpayments\/"},"modified":"2023-01-31T18:03:24","modified_gmt":"2023-01-31T18:03:24","slug":"cms-finalizes-risk-adjustment-policies-to-combat-medicare-advantage-overpayments","status":"publish","type":"post","link":"https:\/\/wheretobuymarijuanaseeds.com\/cms-finalizes-risk-adjustment-policies-to-combat-medicare-advantage-overpayments\/","title":{"rendered":"CMS Finalizes Risk Adjustment Policies to Combat Medicare Advantage Overpayments"},"content":{"rendered":"

The Centers for Medicare and Medicaid Services (CMS) has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations (MAOs).[0]<\/a><\/sup> On Feb. 1, the CMS is slated to finalize the Risk Adjustment Data Validation rule, which would increase the amount of overpayments Medicare Advantage insurers must return to the government.[0]<\/a><\/sup><\/p>\n

Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services (CMS), declared that CMS is devoted to shielding individuals with Medicare and being a reliable guardian of taxpayer money.[1]<\/a><\/sup> In this rule, we are striving to protect Medicare access for the present and future. We have taken into account a great deal of feedback from interested parties and created a well-thought-out system for monitoring the Medicare Advantage program that is comparable to how we oversee the usual Medicare.[2]<\/a><\/sup><\/p>\n

HHS Secretary Xavier Becerra said, \u201cProtecting Medicare is one of my highest responsibilities as Secretary, and this commonsense rule is a critical accountability measure that strengthens the Medicare Advantage program. CMS has a responsibility to recover overpayments across all of its programs, and improper payments made to Medicare Advantage plans are no exception.\u201d[2]<\/a><\/sup><\/p>\n

Private Medicare carriers generated an estimated $17 billion through overpayments last year, according to a report the Medicare Payment Advisory Commission (MedPAC) issued this month.[0]<\/a><\/sup> MAOs are required to submit data to CMS about patient diagnoses and the agency can audit the data to determine if Medicare over- or underpaid for the diagnoses.[1]<\/a><\/sup><\/p>\n

The implemented policies will enable CMS to direct their audits towards MAOs that present the greatest risk of receiving improper payments.[1]<\/a><\/sup> However, CMS will not impose major penalties until audits for payment years 2018 and beyond are conducted.[3]<\/a><\/sup><\/p>\n

Matt Eyles, president of the trade group AHIP, said in a statement, \u201cOur view remains unchanged: This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized.[4]<\/a><\/sup> This rule will be detrimental to the elderly, exacerbate health disparities, and be prejudicial towards those who require the most medical attention.[5]<\/a><\/sup> Additionally, the rule would cause seniors and taxpayers to pay higher prices, those who opt for MA to receive fewer benefits, and fewer plan options to be available in the future.[5]<\/a><\/sup> It is our hope that CMS will continue to collaborate with us in order to ensure the health and economic wellbeing of the American people through our joint public-private partnership.[5]<\/a><\/sup><\/p>\n

0. <\/span>“CMS RADV rule increases Medicare Advantage, provider audits” Modern Healthcare, 24 Jan. 2023, https:\/\/www.modernhealthcare.com\/insurance\/cms-radv-rule-medicare-advantage-provider-audits-oak-street-health-agilon-health<\/a><\/p>\n

1. <\/span>“HHS Issues Final Rule to Protect Medicare, Strengthen Medicare Advantage, and Hold Insurers Accountable” EIN News, 30 Jan. 2023, https:\/\/www.einnews.com\/pr_news\/614228910\/hhs-issues-final-rule-to-protect-medicare-strengthen-medicare-advantage-and-hold-insurers-accountable<\/a><\/p>\n

2. <\/span>“HHS Finalizes Medicare Advantage Risk Adjustment Data Validation Program Rule” HealthPayerIntelligence.com, 30 Jan. 2023, https:\/\/healthpayerintelligence.com\/news\/hhs-finalizes-medicare-advantage-risk-adjustment-data-validation-program-rule<\/a><\/p>\n

3. <\/span>“Government Lets Health Plans That Ripped Off Medicare Keep the Money” Kaiser Health News, 30 Jan. 2023, https:\/\/khn.org\/news\/article\/cms-audits-medicare-advantage-plans-can-keep-hundreds-of-millions-in-federal-overpayments-maybe-more\/<\/a><\/p>\n

4. <\/span>“Medicare Advantage plans lose out in final RADV audit rule that ditches fee-for-service adjuster” FierceHealthcare, 30 Jan. 2023, https:\/\/www.fiercehealthcare.com\/payers\/medicare-advantage-plans-lose-out-final-radv-audit-rule-ditches-fee-service-adjuster<\/a><\/p>\n

5. <\/span>“CMS issues final rule on the Medicare Advantage risk adjustment program” Healthcare Finance News, 30 Jan. 2023, https:\/\/www.healthcarefinancenews.com\/news\/cms-issues-final-rule-medicare-advantage-risk-adjustment-program<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

The Centers for Medicare and Medicaid Services (CMS) has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations (MAOs).[0] On Feb. 1, the CMS is slated to finalize the Risk Adjustment Data Validation rule, which would increase the amount of overpayments Medicare Advantage insurers must return to the government.[0] […]<\/p>\n","protected":false},"author":2,"featured_media":496,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"_links":{"self":[{"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/posts\/497"}],"collection":[{"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/comments?post=497"}],"version-history":[{"count":0,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/posts\/497\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/media\/496"}],"wp:attachment":[{"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/media?parent=497"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/categories?post=497"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wheretobuymarijuanaseeds.com\/wp-json\/wp\/v2\/tags?post=497"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}