Risk Adjustment Data Validation
The centers of Medicare and Medicaid services, will be putting into place a new payment collection method and the belief is that the risk adjustment data validation will increase a good amount. The risk adjustment data validation is what is used to determine the payment error calculation for those beneficiaries of Medicare and Medicaid programs. The overpayment recoveries amounts for the year 2011 are expected to be increased by the centers for Medicare and Medicaid services.
The goal of risk adjustment data validation is to be able to confirm the coding that is done for the beneficiaries of any Medicare programs. It is a way of auditing the information of patient interactions and charts as a way to ensure that the information provided matches the needs and services rendered to the individual. The information about a patient will be audited by the centers of Medicare and Medicaid services in order to check for accuracy that the compensation matches the real state of health of the member. If the circumstance arises that the payment made to the insurance company exceeds the actual need of the patient then the insurance company is responsible for paying back the overpayment amount to the centers of Medicare and Medicaid.
All of the members who are currently enrolled in a plan with Medicare or Medicaid are divided by the categories used in the Hierarchical Condition Categories. The categories and codes that are included represent an illness or sickness and also correspond with a specific quantity of funding required to care for a person who has been diagnosed with that illness. With each of the categories that is applied to a patient, their insurance companies are compensated that specific financial amount based on the number and severity of codes.
The past year was the first time that this new auditing system was put in place by CMS. It is hoped that this program will be a good start in a mission to gain back some of the overpayments that have been made by the centers of Medicare and Medicaid services through a number of different programs. The centers of Medicare and Medicaid services are estimating that potentially over 300 million dollars' worth of overpayments may be collected through the RADV program. This program can be a positive factor on ways to help improve our health care system and the rising costs that the public is faced with on a day to day basis.
To learn more about RADV go to Altegra Health.
The goal of risk adjustment data validation is to be able to confirm the coding that is done for the beneficiaries of any Medicare programs. It is a way of auditing the information of patient interactions and charts as a way to ensure that the information provided matches the needs and services rendered to the individual. The information about a patient will be audited by the centers of Medicare and Medicaid services in order to check for accuracy that the compensation matches the real state of health of the member. If the circumstance arises that the payment made to the insurance company exceeds the actual need of the patient then the insurance company is responsible for paying back the overpayment amount to the centers of Medicare and Medicaid.
All of the members who are currently enrolled in a plan with Medicare or Medicaid are divided by the categories used in the Hierarchical Condition Categories. The categories and codes that are included represent an illness or sickness and also correspond with a specific quantity of funding required to care for a person who has been diagnosed with that illness. With each of the categories that is applied to a patient, their insurance companies are compensated that specific financial amount based on the number and severity of codes.
The past year was the first time that this new auditing system was put in place by CMS. It is hoped that this program will be a good start in a mission to gain back some of the overpayments that have been made by the centers of Medicare and Medicaid services through a number of different programs. The centers of Medicare and Medicaid services are estimating that potentially over 300 million dollars' worth of overpayments may be collected through the RADV program. This program can be a positive factor on ways to help improve our health care system and the rising costs that the public is faced with on a day to day basis.
To learn more about RADV go to Altegra Health.