Sep
3, 2019
The health
insurance industry again is attacking federal proposals that would more
aggressively audit Medicare Advantage claims for improper coding — audits that
would save taxpayers upwards of $4.5 billion over the next decade.
The big
picture: Medicare Advantage is the growth
engine of the insurance industry, which has successfully delayed
changes and neutered audits.
Between the
lines: The audits, called "risk adjustment data validation,"
have created paranoia among insurers for years. The federal government created
the audits as a way to make sure insurers' records of patients' diagnoses
matched up to their medical records.
- Medicare
Advantage insurers have exaggerated
diagnoses as a way to get higher payments from the federal
government, costing taxpayers billions of dollars over the past decade.
Driving the
news: The Centers for Medicare & Medicaid Services gave the
industry until
the end of August to send in more comments on a beefed-up
auditing process. Insurers still hate everything about it.
- America's
Health Insurance Plans, the industry's primary lobbying group, told CMS 8
times in its comment
letter to withdraw the entire rule.
- The
Blue Cross Blue Shield Association and several regional insurers criticized the
idea of removing a formula that adjusted Medicare Advantage overpayments
based on errors in the regular Medicare program.
- Centene warned the
audits could lead to more "market consolidation."
The Medicare
Payment Advisory Commission again stood alone as a supporter of
the government's auditing process.
What's
next: Federal officials will make a final call on the auditing changes
later this year, with the entire industry pressuring them to kill or
substantially scale back their changes. It's possible insurers would take this
to court if the changes go through.
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