“For the Medicare Advantage (MA) program, CMS contracts with private insurance companies, known as MA organizations (MAOs), to provide Medicare coverage for 18.6 million beneficiaries. In fiscal year 2016, MA expenses reached $200 billion. In 2012, CMS began collecting detailed information from MAOs regarding each service provided to MA beneficiaries. This information is known as encounter data…”
“We analyzed 102 million MA encounter records from the first quarter of 2014 to determine the extent to which data contained in CMS’s Integrated Data Repository were complete, valid, and timely. In addition, to review the actions that CMS has taken to address errors in MA encounter data, we analyzed CMS’s responses…”
“Overall, 28 percent of MA encounter records that we reviewed from the first quarter of 2014 had at least 1 potential error, but CMS reported correcting the majority of these records. According to CMS, most of these potential errors were created when CMS removed provider identifiers from record…”
“We recommend that CMS take actions as appropriate to…”
Source: Medicare Advantage Encounter Data Show Promise for Program Oversight, But Improvements Are Needed, January 2018. Office of the Inspector General, HHS. Read the full report here.
