The release of the payment model for 2011 by the centers of Medicare and Medicaid services is expected to have a large increase in the risk adjustment data validation aspect, otherwise known as RADV. The payment error calculation method for those enrolled in programs sponsored by Medicare and Medicaid is that of the risk adjustment data validation. The amount of overpayment recoveries that are to be made for 2011 are reported to be increasing by the centers of Medicare and Medicaid services.
The hierarchical Condition Categories are utilized to create diagnostic codes for Medicare and Medicaid beneficiaries as a way to categorize the plans members. Each of these categories and codes represents a disease or illness, and each of these codes is also accompanied by a general monetary value of having to care for one with these afflictions. When a patient is assigned a code or category, their insurance company is then reimbursed for the specific monetary amount that is associated with that particular illness.
The purpose of the risk adjustment data validation is to be able to check for the correct and accurate coding of these patients and their charts. It allows the centers for Medicare and Medicaid to ensure that the care the patient has received or is in need of matches the codes assigned to them. Through the centers of Medicare and Medicaid services audits will be completed as a way to ensure that the information coded matches the actual health of the patient or member. In the case that the audit does not match the information provided by the health insurance company, the difference in the overpayment made to the insurance company by the centers for Medicare and Medicaid services will be returned to them.
Last year was the first instance of having this system put into place by the centers for Medicare and Medicaid. Many believe that the system is going to be a good way to recover a number of accidental overpayments which have greatly increased the costs of a number of programs. There have been a number of estimations made about the potential amount of funding to be recovered by this program, and many of them believe the recovery may be over 300 million dollars. It is hoped that this programs and similar programs will help with the possible reduction of health care costs as they continue to rise in the current health care system.
To know more about Risk Adjustment Data Validation go to Altegra Health.
The hierarchical Condition Categories are utilized to create diagnostic codes for Medicare and Medicaid beneficiaries as a way to categorize the plans members. Each of these categories and codes represents a disease or illness, and each of these codes is also accompanied by a general monetary value of having to care for one with these afflictions. When a patient is assigned a code or category, their insurance company is then reimbursed for the specific monetary amount that is associated with that particular illness.
The purpose of the risk adjustment data validation is to be able to check for the correct and accurate coding of these patients and their charts. It allows the centers for Medicare and Medicaid to ensure that the care the patient has received or is in need of matches the codes assigned to them. Through the centers of Medicare and Medicaid services audits will be completed as a way to ensure that the information coded matches the actual health of the patient or member. In the case that the audit does not match the information provided by the health insurance company, the difference in the overpayment made to the insurance company by the centers for Medicare and Medicaid services will be returned to them.
Last year was the first instance of having this system put into place by the centers for Medicare and Medicaid. Many believe that the system is going to be a good way to recover a number of accidental overpayments which have greatly increased the costs of a number of programs. There have been a number of estimations made about the potential amount of funding to be recovered by this program, and many of them believe the recovery may be over 300 million dollars. It is hoped that this programs and similar programs will help with the possible reduction of health care costs as they continue to rise in the current health care system.
To know more about Risk Adjustment Data Validation go to Altegra Health.
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