The Biden administration finalized an oft-delayed plan to step up audits of Medicare Advantage insurers in order to identify and recover overpayments.
It comes as more seniors are choosing private Medicare Advantage plans over traditional Medicare andThe Centers for Medicare and Medicaid Services does audits called risk adjustment data validation, or RADV, to identify improper payments.that would extrapolate results over a Medicare Advantage plan's entire patient population.
"This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized," Matt Eyles, president and CEO of the insurers' lobby AHIP, said in a statement on the policy. "The rule will hurt seniors, reduce health equity and discriminate against those who need care the most." “This rule comes with enormous costs and fails to target the most egregious diagnosis coding violations,” Alliance of Community Health Plans President and CEO Ceci Connolly said in a statement.Insurers have questioned whether parts of Medicare's methodology are legal and could challenge the rule in court.
The higher costs to plans could lead some insurers to pull out of markets — and beneficiaries could face higher costs, fewer plan choices or reduced supplemental benefits under the Medicare Advantage program, perCMS will also release an advanced notice of Medicare Advantage rates for 2024 soon. The payment notice could offset some market concerns raised for health plans by the RADV proposal, said Raymond James analyst Chris Meekins.The real impact on plans will likely be quite small.
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