MedPAC turns to MA payment withholding to improve encounter data

A key Medicare advisory panel wants Congress to pass legislation to withhold a portion of Medicare Advantage plan payments and not return it if the insurer’s encounter data is incomplete or inaccurate.

The Medicare Payment Advisory Commission, which passed the recommendation during its April meeting Thursday, wants Congress to direct the CMS to start withholding in 2021 and release standards and performance metrics that plans can meet to get it back. The recommendation comes as the CMS will use more encounter data to influence its payments to Medicare Advantage plans.

The recommendation does not list a percentage that the agency should take from plan payments.