Medicare & Medicaid
Risk adjustment data validation ensures payment integrity and accuracy – and it affects what plans are paid.
Barring an appeals court decision overturning the rule, the mandate goes into effect on January 1, 2021.
PhRMA questions the cost savings and says the rule leaves safety considerations to state governments, rather than the required federal oversight.
The treatment will be available at no cost to patients, although healthcare facilities may charge for the administration.
The interim rule would cut drug reimbursements to hospitals by an average of 65% when fully phased in, the AHA says.
The old federal regulations burdened providers with added administrative costs and fear of financial consequences, CMS says.
Opponents say the rule will not lower drug prices, and some question whether it is legal, having bypassed the public comment process.
The letter warns that the new thresholds are too high and will force many clinicians to exit from APMs and revert back to fee-for-service.
Medicare negotiation could result in 94,000 fewer deaths annually, and reduce spending by $475.9 billion by 2030.
The allegations were brought by a whistleblower former employee who will receive about $1.5 million as her share of the recovery.