06 Feb Health Data News Roundup: Medicare Advantage Audit Ruling; Lack of Encounter Data for MA Supplemental Benefits; and Cigna Reduced Care Costs

Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today’s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals.

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers
The Biden administration is cracking down on Medicare private plans that have overcharged the federal government. The rule calls for a more aggressive approach to how plans are audited in the Medicare Advantage program.

7 Reactions to CMS’ Medicare Advantage Audit Ruling
Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create higher premiums and fail to target fraud. Others say the new rule, which eliminates the fee-for-service adjuster, doesn’t go far enough, according to this Becker’s Payer Issues article.

GAO: CMS Lacks Encounter Data for MA Supplemental Benefits
Nearly all Medicare Advantage plans offered supplemental benefits in 2022, but CMS received limited encounter data from the plans, a report from the Government Accountability Office (GAO) found.

CMS Announces ACA Special Enrollment Period during PHE Unwinding
CMS announced that there will be a special enrollment period on the Affordable Care Act marketplace for individuals who lose their Medicaid coverage due to the public health emergency unwinding.

Cigna’s Integrated Health Plan Reduced Care Costs for Employers
Employers saved more than $1,400 per member per year when employees enrolled in Cigna’s integrated health plan that coordinates medical, pharmacy, and behavioral benefits, according to a study from the payer.

House Lawmakers Introduce Bills to Amend VA EHR Modernization Program
Rep. Mike Bost, R-Ill., House Committee on Veterans’ Affairs chair, recently introduced legislation to significantly amend or scrap the Department of Veterans Affairs (VA) EHR modernization program completely.