“In its recent notice of proposed rulemaking setting policy for Medicare Advantage (MA) and the Prescription Drug Program (PDP) for calendar year 2020, CMS announced that it would establish extrapolation as a method to be used in risk adjustment validation (RADV) audits, and further, that it would not make any adjustments to account for errors in Medicare fee for service data in determining recovery amounts…”
“CMS is using the proposed rule as an opportunity to announce that it “intends to recover overpayments based on extrapolated audit findings through the use of statistically valid random sampling techniques.” That is, CMS will perform RADV audits of a sample of claims, will aggregate discrepancies to determine an overall payment error rate, and will extrapolate the rate to calculate a contract-level payment error estimate. The use of extrapolation would represent a significant expansion of CMS’s auditing practices…” Read the full article here.
Source: CMS Announces and Solicits Comments on Expanded RADV Audit Methodology – By Barbara H. Ryland and Joseph Records, November 12, 2018. C&M Health Law.
