Next stop for the Recovery Auditors (RAs) is Medicare Part C, according to the recently issued statement of work (SOW) from the Centers for Medicare & Medicaid Services (CMS). CMS would like to enter into a contract with an RA to identify under- and overpayments. The agency currently conducts risk adjustment data validation (RADV) audits of 30 Medicare Advantage plans, representing 5 percent of the total, but it would like to include all Medicare Advantage organizations. The driver: a reported 9.5 percent improper payment rate.
Perhaps no other regulatory matter raises the immediate ire of healthcare professionals more than the conflicting and contradictory issues associated with Medicare Advantage plans. Nearly every facility has challenges with Medicare Advantage.
As a consequence, Monitor Mondays be reporting on this hot-button issue during a special edition broadcast on Wednesday, March 23, 2016, featuring healthcare attorney David Glaser. Frustrations aired. Solutions offered.