Ayla Ellison: 6 Things To Know About Medicare Advantage

1. The Balanced Budget Act of 1997. Payments made to Medicare managed care organizations are adjusted to reflect the relative health status of enrollees
2. CMS calculates a risk score each year for each Medicare Advantage enrollee
3. CMS conducts Risk Adjustment Data Validation audits to validate the accuracy of diagnosis data submitted to CMS for payment by Medicare Advantage organizations
4. The condition-specific audits would focus on conditions, such as diabetes, that have a higher probability of being erroneous
5. 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
6. 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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