The expectations for the new payment model to be released by the Centers for Medicare and Medicaid services are to have an increase in the risk adjustment data validation, also known as RADV. It is this risk adjustment data validation that is put in place as a means to create the computation of payment error for a number of Medicare or Medicaid beneficiaries. There have been reports made that the recovery of overpayments that are scheduled will be increased by the centers for Medicare and Medicaid this year.
Every member who is a part of a Medicare or Medicaid sponsored plan is provided with diagnostic codes found in the Hierarchical Condition category as a way to categorize the members of a plan. Every category, or code, is representative of a specific illness of disease and is also linked with a monetary value of the cost to care for this type of illness. Each code that is assigned to a patient becomes the specific dollar amount that their insurance company receives for compensation of covering the patient with that illness.
The purpose of completing a risk adjustment data validation is to make sure that the individuals are actually in need of, or have already received the care that is specified in their charts. It allows the centers for Medicare and Medicaid a way to ensure the compensation for the specific member is accurate and matches the information provided. The centers for Medicare and Medicaid services will audit the information passed from insurance companies to health care providers and check to see whether or not he codes that were applied are accurate. In some instances where the payment to the insurance company through the centers of Medicare and Medicaid is more than what is justified for the plan member, the overpayment is required to be paid back by the insurance company.
The centers for Medicare and Medicaid services have put this system into effect for the first time in 2011. It is believed that this new system will be a dynamic part of getting some of the funding which was accidentally granted because of improperly coded charts back to the Centers for Medicare and Medicaid servies. Estimations have been made that the program will be successful in recovering overpayments made by the centers of Medicare and Medicaid services in amounts over 300 million dollars. Some believe that this program can be a good start to decreasing the ever rising costs of our current health care system, a topic which continues to be controversial within our nation.
To learn more about RADV go to Altegra Health.
Every member who is a part of a Medicare or Medicaid sponsored plan is provided with diagnostic codes found in the Hierarchical Condition category as a way to categorize the members of a plan. Every category, or code, is representative of a specific illness of disease and is also linked with a monetary value of the cost to care for this type of illness. Each code that is assigned to a patient becomes the specific dollar amount that their insurance company receives for compensation of covering the patient with that illness.
The purpose of completing a risk adjustment data validation is to make sure that the individuals are actually in need of, or have already received the care that is specified in their charts. It allows the centers for Medicare and Medicaid a way to ensure the compensation for the specific member is accurate and matches the information provided. The centers for Medicare and Medicaid services will audit the information passed from insurance companies to health care providers and check to see whether or not he codes that were applied are accurate. In some instances where the payment to the insurance company through the centers of Medicare and Medicaid is more than what is justified for the plan member, the overpayment is required to be paid back by the insurance company.
The centers for Medicare and Medicaid services have put this system into effect for the first time in 2011. It is believed that this new system will be a dynamic part of getting some of the funding which was accidentally granted because of improperly coded charts back to the Centers for Medicare and Medicaid servies. Estimations have been made that the program will be successful in recovering overpayments made by the centers of Medicare and Medicaid services in amounts over 300 million dollars. Some believe that this program can be a good start to decreasing the ever rising costs of our current health care system, a topic which continues to be controversial within our nation.
To learn more about RADV go to Altegra Health.
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