News: CMS could use extrapolation to determine MA paybacks

CMS proposes to extrapolate results from Medicare Advantage (MA) audits and apply an overall error rate for all plans, according to an article in FierceHealthcare, raising the ire of insurers and physicians.

Typically, as with other federal healthcare payment programs, CMS conducts random audits to determine the accuracy of the claims. Only audited facilities with identified errors need to refund overpayments. Under the proposal, however, CMS plans to “extrapolate the results from the audits to apply to an overall error rate for all plans,” according to the article.

In comments due to CMS this week, America's Health Insurance Plans (AHIP), called the proposal “neither fair nor appropriate,” FierceHealthcare reported.