An existent compliance plan not only detects incorrect coding practices, it may also be considered by some federal agencies when determining whether reasonable efforts were taken to avoid and detect ...

Internal Auditing is an independent, objective assurance and consulting activity designed to add value and improve an organization's operations. It helps an organization accomplish objectives by ...

A new overhaul to Medicare Advantage (MA) risk adjustment audits will still leave billions on the table if the Biden administration doesn’t go further, a group of experts contend. Several experts ...

Increased oversight seems set to focus most intensely on risk-adjustment data validation (RADV), which confirms medical records support diagnoses used for patients. Noting in its recent announcement ...

The AI-enabled solution addresses expanded CMS RADV requirements with automated workflows, audit-ready reporting, and scalable operations developed based on insights from leading health plans.

In 2016, the Centers for Medicare & Medicaid Services started focused on-site surveys to address the issue of erroneous coding of schizophrenia in nursing homes. More recently, the agency began ...