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Cms Proposes Rule For 2018 Risk Adjustment Payments - Latest News

CMS Issues Final Rule On 2018 Risk Adjustment Methodology; Litigation Likely To Continue

CMS is also likely to address additional changes to the risk adjustment program in the forthcoming notice of benefit and payment parameters ... to that laid out in the final rule for the 2017 methodol... read more

CMS Issues Proposed Rule Addressing Payment Error In Medicare Advantage, Expects To Recover $4.5 Billion Over 10 Years

A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) on October 26, 2018, would revise the way ... in the methodology for determining risk adjustment data audit recoveries. CMS’ ... read more

CMS' final rule on risk adjustment payments: 3 things to know

CMS issued a final rule to continue its ... for the HHS-operated Permanent Risk Adjustment Program for 2018 reissues the risk adjustment methodology HHS used for the 2018 benefit year. 3. CMS initiall... read more

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CMS finalizes plan to continue risk-adjustment program for 2018

The CMS ... payments to insurers for 2017 under the risk-adjustment program, but later that month issued a final rule restoring the program for that year. The rule released Friday allows CMS to move o... read more

Risk-Adjustment Fix Finalized for 2018 After Bout of Uncertainty

The freeze lasted only two-and-a-half weeks until CMS announced a final rule to resume the payments ... A similar fix for the 2018 benefit year was proposed two weeks later. Risk-adjustment payment po... read more

CMS finalizes risk adjustment rule for benefit year 2018

The Centers for Medicare & Medicaid Services (CMS) finalized its risk adjustment rule for the 2018 benefit year on Friday, its latest step in a string of legal battles dating back to earlier this year ... read more

CMS reinstates risk adjustment program for ACA exchanges

In a new final rule, CMS reissued the Affordable Care Act's risk adjustment program for payers in the ACA exchanges for the 2018 benefit year ... temporarily froze more than $10 billion in payments to ... read more

ACP's initial review of QPP proposed rule 'encouraging'

The American College of Physicians (ACP) is encouraged that the 2018 proposed rule to implement the Quality Payment Program (QPP), released ... exemptions available for different groups. 5. Risk Adjus... read more

DOJ Intervenes in Medicare Advantage FCA Case Against Provider

On December 11, 2018 ... for Medicare Advantage patients in order to increase reimbursements from Medicare. The Relator’s complaint alleges that Sutter received “hundreds of millions of dollars in inf... read more

HHS to appeal New Mexico court's risk adjustment ruling

Meanwhile, earlier this week CMS finalized its risk adjustment payment rule for benefit year 2018, incorporating additional context about its decision to use state-based average premiums. CMS Administ... read more

DOJ takes up lawsuit accusing Sutter Health of cheating Medicare

Under a proposed rule issued by CMS last ... The plan for Risk Adjustment Data Validation (RADV) audits could save the government $4.5 billion in recovered payments over a decade, according to CMS. Th... read more

CMS seeks 2% payment increase for inpatient rehab facilities

Medicare's inpatient rehabilitation facility payment rates could increase by up to 2% in fiscal 2014, under a rule proposed by the CMS (PDF ... the data elements necessary to accommodate risk adjustme... read more

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