OIG Reviews Medicare Advantage Claims

by  Wyn Staheli, Director of Research
February 1st, 2018

On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that:

"Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; and beneficiary information that did not match CMS's records. Just 1 percent of MAOs submitted 51 percent of the records with potential error(s). Some of these errors may raise concerns about the legitimacy of services documented in the data, such as records that lacked a beneficiary last name or a valid identifier for the billing provider."

Consequently, the OIG is recommending that CMS begins to address these 'potential' errors and require further information from Medicare Advantage Organizations (MAOs) to evaluate the data. Providers may likely see an increase in the number of records requests from MAOs' remember it is important to respond promptly to these requests.

References:

• Medicare Advantage Encounter Data Show Promise for Program Oversight, But Improvements Are Needed