The Centers for Medicare and Medicaid Services has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations. Studies and audits done separately by CMS and the Health and Human Services Office of Inspector General have shown that Medicare Advantage enrollees' medical records do not always support the diagnoses reported by
The Risk Adjustment Data Validation rule, which CMS is expected to finalize Feb. 1, would have significant financial implications for insurers and their provider partners.
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. U.S. Health Care Is Harmful to One’s Health Thank you for publishing this research (“Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?” Dec. 21).
On December 14, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that contemplates several changes to, and clarifications of, guidance for the Medicare.