Fact Based List:
Ayla Ellison: 6 Things To Know About Medicare Advantage
Submitted by Anonymous on Mon, 01/04/2016 - 11:46
- The Balanced Budget Act of 1997. Payments made to Medicare managed care organizations are adjusted to reflect the relative health status of enrollees
- CMS calculates a risk score each year for each Medicare Advantage enrollee
- CMS conducts Risk Adjustment Data Validation audits to validate the accuracy of diagnosis data submitted to CMS for payment by Medicare Advantage organizations
- The condition-specific audits would focus on conditions, such as diabetes, that have a higher probability of being erroneous
- To increase MA organizations contracts that are subject to some type of RADV audit, CMS is considering contracting with a Part C RAC to perform comprehensive and condition-specific audits
- CMS said it will determine the next steps for procurement of a Part C RAC after reviewing the comments received in response to the request for information
Source: CMS
Source URL: http://www.beckershospitalreview.com/finance/cms-to-expand-r...
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