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Medicare Advantage Plans Scrutinized More in CMS Audits
Private insurers managing Medicare Advantage plans likely will be scrutinized more intensely as the Centers for Medicare & Medicaid Services seeks to rectify a "longstanding problem" of improper payments.
CMS recently said it may have overpaid Medicare Advantage plans by as much as $12.4 billion in 2011, amounting to an 11% error rate, compared to an 8.6% rate in traditional Medicare, reported Bloomberg.
To help reduce that error rate, CMS auditors will examine 30 plans to determine whether clinical records justify payments for medical services. The auditors will review 200 patients' medical records and calculate the percentage of improper payments. Medicare will then reduce future payouts to the insurer to recoup any overpayments.
"We're absolutely confident that this is a valid sample to do these audits," Medicare Deputy Administrator Jonathan Blum told Bloomberg.
Read more at: http://tinyurl.com/6w7htgn
Source: FierceHealthPayer; Bloomberg
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
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Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
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Making Giant Strides in Maternity Health Through Baby Steps
April 9th 2024To help celebrate and recognize National Minority Health Month, we are kicking off a special month-long podcast series with our strategic alliance partner, UPMC Health Plan. Welcome to our first episode, which is all about the Baby Steps Maternity Program and its mission to support women throughout every step of their pregnancy journey.
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