Health Care Law Brief

APRIL 3, 2023

health condition, age, gender, dual eligibility status, and demographics information) based off a risk score from CMS’s hierarchical condition category (HCC). All ICD codes are grouped into diagnostic groups with similar medical conditions and then condition categories based on clinical profiles and expected costs (e.g.,

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Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

FEBRUARY 2, 2023

To that end, the agency doubled its budget for audits in 2022. Begin by setting the scope to establish clear parameters regarding the time period you want to cover and the error categories you will look for in the audit. The information can also serve as the basis for provider education. The next step is to plan the audit.

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Healthcare Law Blog

SEPTEMBER 28, 2023

Refresher on the RADV Final Rule The Final Rule will implement the following changes: CMS will extrapolate RADV audit findings beginning with payment year (“PY”) 2018, and will not extrapolate RADV audit findings for PYs 2011 through 2017, though it will continue to collect the non-extrapolated overpayments that are identified.

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Medicare Medicare Overpayments Overpayment 52