Blue Cross Official Says Details on MA Audits On Risk Adjustment Should Be Revealed Soon

Medicare Advantage plans should soon learn more details about the Centers for Medicare & Medicaid Services’ approach to an audit program that may put some at significant financial risk, an official with the Blue Cross and Blue Shield Association said July 11.

Addressing a session of the Medicare Advantage Compliance Symposium, Jane Galvin, director of regulatory affairs for BCBSA, predicted that CMS is expected to “reach closure” shortly—perhaps this summer—on the methodology for payment error calculation in risk adjustment data validation (RADV) audits.

This will indicate how plans that fail to pass audits could be penalized through payment recovery.

“We ...