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Medicare Advantage: Fundamental Improvements Needed in CMSs Efforts to Recover Substantial Amounts of Improper Payments
Medicare Advantage: Fundamental Improvements Needed in CMSäó»s Efforts to Recover Substantial Amounts of Improper Payments
Our Price: $20.00
By James Cosgrove (au)
Year: 2016
Pages: 38
Binding Paperback
ISBN 978-1-4578-7351-5

Product Code: 1457873516

In 2014, Medicare paid about $160 billion to Medicare Advantage (MA) organizations to provide health care services for approximately 16 million beneficiaries. The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, estimates that about 9.5% of its payments to MA organizations were improper, according to the most recent data -- primarily stemming from unsupported diagnoses submitted by MA organizations. CMS currently uses risk adjustment data validation (RADV) audits to recover improper payments in the MA program. This report examines the extent to which (1) CMSs contract selection methodology for RADV audits facilitates the recovery of improper payments; (2) CMS has completed RADV audits and appeals in a timely manner; and (3) CMS has made progress toward incorporating RACs into the MA program to identify and assist with improper payment recovery. Figures. This is a print on demand report.

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