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).
If your organization participates in Medicare Advantage, you need to know whether your Medicare overpayments, as well as underpayments, are accurate. To do so, you need to know the process used when Medicare audits claims. Understanding how this auditing process works, at least at a contextual level, is important and will be explained during this important webcast being conducted by author, educator, and consultant Duane Abbey.
From this webcast, you will you will gain a greater understanding of Medicare Advantage, and…
- Learn the payment process that Medicare uses to pay MAOs for the services provided to Medicare beneficiary enrolled in Medicare Advantage programs.
- Understand the key RADV and its impact on reimbursement.
- Learn the role Recovery Audit Contractors (RACs) are supposed to play in auditing RADV for proper payment.
- Understand the impact of HCCs on reimbursement.
- Learn the types of audits associated with determining proper payment through RADV including statistical extrapolation.
Why is This Webcast 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. 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.