CMS Extends Medicare Advantage Audit Program in 2019 Rule

CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers.  The proposed rule extends the use of RADV audits to previous and future plan years, and changes how CMS will review MA payments.

RADV audits will now calculate the accuracy of an MA plan’s risk adjustment conditions based on beneficiary characteristics in a small sample of plan enrollees. The audits will validate hospital inpatient, hospital outpatient, and physician/practitioner medical records and adjust MA payments accordingly.

Source: https://healthpayerintelligence.com/news/cms-extends-medicare-advantage-audit-program-in-2019-rule