tci Medicare Compliance & Reimbursement - 2015 Issue 23
Medicare Advantage: CMS to Scrutinize VBID Participants
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Article Overview
This article covers CMS monitoring and beneficiary protection measures tied to the Medicare Advantage Value-Based Insurance Design (VBID) model. It is relevant for Medicare Advantage stakeholders, compliance teams, and coding or managed care professionals who need a high-level understanding of how CMS is supervising plan participation, marketing practices, complaints, and data monitoring related to the model.
Why This Topic Matters
It helps readers understand the compliance and operational oversight environment surrounding VBID participation, including the types of safeguards CMS has put in place and the areas it intends to monitor closely.
What You Will Learn
- The purpose of CMS oversight in the Medicare Advantage VBID model
- The types of enrollee protections and plan safeguards associated with VBID
- How CMS plans to monitor marketing, complaints, provider concerns, and plan data
- Why VBID participation is subject to continued surveillance and auditing
Who Should Read This
- Medicare Advantage plans
- Compliance professionals
- Medical coders
- Managed care administrators
- Healthcare reimbursement professionals
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