Healthcare IT Today

FEBRUARY 2, 2023

To that end, the agency doubled its budget for audits in 2022. These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). These actions are more than just saber-rattling.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). Base rates are risk adjusted to account for certain factors related to a beneficiary (e.g., See 88 Fed. 6643 (Feb.

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Medicare Medicare Overpayments Overpayment 52

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. The Final Rule therefore violates the APA’s requirement for the Defendants to put forth reasoned agency decision-making.

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Medicare Medicare Overpayments Overpayment 52