White Papers

CMS, Overpayments, and the Final 60-Day Rule

CMS, Overpayments, and the Final 60-Day Rule

What Medicare Advantage Organizations, health plans, and other affected groups need to know (and do) if they want to comply with the new overpayments rule – including how to establish and enforce effective policies and procedures, deploy advanced algorithms to identify overpayments, educate providers, and develop an overarching strategy that protects against the serious consequences of overpayments.

Demystifying CMS’ New Risk Adjustment Scoring System

Demystifying CMS’ New Risk Adjustment Scoring System

An enormous change is sweeping through health plans and Medicare Advantage Organizations (MAOs): Centers for Medicare and Medicaid Services (CMS) is beginning to incorporate diagnoses from CMS’s Encounter Data System (EDS) into the risk scores used in payment, slowly transitioning away from the more basic Risk Adjustment Payment System (RAPS).