Revenue Cycle Advisor January 29, 2018
The Office of Inspector General (OIG) recently released a report that found potential errors in 28% of Medicare Advantage (MA) encounter records and provides recommendations to CMS for properly addressing potential errors.
Under the Medicare Advantage program, CMS contracts with private insurance companies known as MA organizations (MAOs), to provide Medicare coverage for beneficiaries.
In 2012, CMS began collecting MA encounter data, or information from the MAOs on the services they provide to MA beneficiaries. This data is contained in CMS’s Integrated Data Repository and used by CMS to determine the types of medical care beneficiaries receive. It is also used to identify MAOs in need of higher payments for beneficiaries in poor health.
To determine the timeliness, validity, and...
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