by Wyn Staheli, Director of Content - innoviHealth
Feb 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.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.