The AHA Nov. 11 voiced strong support for the Centers for Medicare & Medicaid Services’ proposed plan for data collection and reporting requirements for Medicare Advantage organizations. In addition, the AHA supports CMS’ proposed audit protocol, which would assess MAO compliance with MA utilization management program requirements codified in the calendar year 2024 MA final rule.  

The AHA provided detailed comments on the scope and mechanisms for required reporting and identified opportunities to increase public transparency of MAO performance. In addition, the AHA provided specific recommendations to strengthen requirements and reporting related to MAOs’ use of internal coverage criteria, compliance with the two-midnight benchmark and access to post-acute care — where hospitals and health systems report the greatest challenges and concerns with MA practices diverging from Medicare rules and requirements. AHA also identified other priority areas warranting increased oversight, including MAO requests for additional documentation, peer-to-peer requests, member appeals and business practices of third-party vendors.

Related News Articles

Headline
An analysis by KFF released last week found that in 2022, Medicare spent 27% ($2,585) more, on average, for individuals covered by Traditional Medicare after…
Headline
The Centers for Medicare & Medicaid Services Nov. 26 proposed changes to the Medicare Advantage and prescription drug programs for contract year 2026.…
Headline
A report released OCt. 23 by Kodiak Solutions found that Medicare Advantage plans classified three to four times as many hospital stays as observation visits…
Headline
A report released Oct. 24 by the Office of Inspector General found that insurers received an estimated $7.5 billion in Medicare Advantage risk-adjustments for…
Headline
Medicare open enrollment for 2025 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
The AHA Oct. 17 released its Health Care Plan Accountability Update, covering the latest developments in Medicare Advantage, legislation and regulation of…