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CHA has issued a members-only summary, prepared by Health Policy Alternatives, Inc., of the rule finalizing technical details about the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. This is the program that’s used to recover improper risk adjustment payments made to MA plans.
- The Centers for Medicare & Medicaid Services (CMS) will not extrapolate RADV audit findings for payment years 2011-2017.
- CMS will extrapolate RADV audit findings beginning with the payment year 2018 RADV audit.
- CMS will not apply an adjustment factor (known as a fee-for-service adjuster) in RADV audits.
Provisions in the regulation are effective April 3.
