Medicare Advantage is like sitting down and confronting a bowl of goulash—a steamy brew of meat, vegetables and broth. You really don't know what you're getting into until it's too late. Medicare Advantage is a brewing stew of compliance issues.
Medicare Advantage is so complex, and guidance so necessary that RACmonitor is producing a two-part webcast series on it, featuring author, educator, and consultant Duane Abbey.
Understanding the differences between Medicare Advantage and traditional Medicare can translate into better reimbursement and less cost in filing and tracking claim adjudication and payment. During Part I, you and your team will gain a greater understanding of Medicare Advantage, paying attention to claims and claim adjudication.
Medicare uses a complex risk-adjustment process when paying Medicare Advantage Organizations (MAOs) for services provided to Medicare beneficiaries who enroll in a Medicare Advantage plan. Of particular interest is the Risk Adjustment Data Valuation (RADV) and associated Hierarchical Condition Categories (HCCs), as you will discover during Part II of this crucially important webcast.
From this webcast series, you will you will gain a greater understanding of Medicare Advantage, and…
- The Medicare Advantage programs and how such programs operate.
- Learn the coverage differences between traditional Medicare and Medicare Advantage programs.
- Understand how reimbursement is conducted by Medicare Advantage.
- Learn the payment process that Medicare uses to pay MAOs for the services provided to Medicare beneficiaries enrolled in Medicare Advantage programs.
- Understand the key RADV and its impact on reimbursement.
- Learn the role that Recovery Audit Contractors (RACs) are supposed to play in auditing RADV for proper payment.
- Understand the impact of HCCs on reimbursement.
Why is This Webcast Series Relevant?
Medicare Advantage programs are becoming more popular, and virtually all healthcare providers are already involved or will become involved with one or more programs.
Understanding the differences between Medicare Advantage and traditional Medicare can translate into better reimbursement and less cost in filing and tracking claim adjudication and payment.
To make certain that overpayments, as well as underpayments, are not being made by Medicare, there must be an auditing process. Understanding how this auditing process works, at least at a contextual level, is important for all healthcare providers that participate in such programs.