A bipartisan group of senators is urging the CMS to work with Congress to crack down on overpayments in Medicare Advantage. In a letter sent to the agency Monday, the lawmakers praised the CMS’ proposal to exclude diagnoses submitted through chart reviews that aren’t linked to actual medical care from risk adjustment — potentially curbing insurers’ ability to inflate their members’ illnesses to reap higher reimbursement from the government. But the senators argued more can be done. Congress could direct the HHS to exclude all diagnoses gleaned from chart reviews and health risk assessments, or screenings that could also be used to exaggerate members’ health conditions, they wrote.
Read the full article: Bipartisan Lawmakers Urge CMS to Crack Down on Medicare Advantage Overpayments //
Source: https://www.healthcaredive.com/news/bipartisan-senators-cms-crack-down-medicare-advantage-overpayments-upcoding/816336/