The Office of Inspector General (OIG) recently released a report estimating that CMS may have overpaid Medicare Advantage Organizations approximately $462 million in 2021 based on unsupported acute stroke diagnoses. For those working in Medicare Advantage risk adjustment, the findings themselves should not come as a surprise.

CMS released the PY2020 Medicare Advantage RADV audit notices on Friday—and this round is significant. A total of 471 Medicare Advantage contracts are now under review, making it the largest audit cohort to date.

CMS recently released an updated Risk Adjustment Data Validation (RADV) Questions & Answers document along with a schedule outlining when upcoming Medicare Advantage RADV audits are expected to begin by payment year. While the release does not introduce major policy changes, it does provide something many organizations have been looking for, which is greater transparency into how CMS intends to sequence future RADV audits.

On Monday, the Centers for Medicare & Medicaid Services released the Calendar Year (CY) 2027 Advance Notice for the Medicare Advantage (MA) and Part D programs. At more than 160 pages, the document pairs a modest projected payment increase with some of the most consequential refinements to MA risk adjustment in recent years.