22 Dec 0
On December 17th CMS released the memo titled “Payment Year (PY) 2013 Overpayment Recovery”. In the memo CMS reaffirms the overpayment regulations contained in 42 CFR §422.326, where all Medicare Advantage (MA) organizations are required to return overpayments. This memo pertains to risk adjustment data submitted with dates of service in calendar year 2012. This data was used to generate payments in calendar year 2013. The memo reminds all MA plans of the process to address any outstanding deletion/redaction data by January 8, 2016.
This memo reaffirms the CMS requirement for plans to submit accurate and complete risk adjustment data. While your calendar year 2012 data isn’t likely a major problem this memo should serve as a reminder to review the risk adjustment submission and data monitoring procedure currently in place. Submitting all risk adjustment data accurately, timely and entirely is a key to success.