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CMS Issues Long-Awaited Medicare Advantage RADV Final Rule

Healthcare Law Blog

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. See also Ratanasen v.

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Compliance Risks Associated with Outlier Payments 


Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).


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Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News

The watchdogs also recommended imposing limits on home-based “health assessments,” arguing these visits can artificially inflate payments to plans without offering patients appropriate care. ” The health plan required patients to have an X-ray first to prove a CT scan was needed. Bliss said Medicare paid $2.6

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Health Provider News

Hall Render

of Labor projects 6000 health care job openings per year Negotiations between Local 17 Nurses and Providence St. Patrick Hospital to take place at later date St.

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Home Health PPS Proposed Rule for CY2023: More Bad News for the Home Health Industry

Hall Render

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment.