Wednesday, August 20, 2014

AHCA Urges Greater Transparency for Managed Care Claims

Drew Thies 

Last week, AHCA urged top Senate leaders to take a closer look at managed care plans and develop better methods for collecting and releasing claims information. The letter, sent to Chairman Ron Wyden (D-OR) and Ranking Member Chuck Grassley (R-IA) of the Senate Finance Committee details four suggestions on which both CMS and Congress can act to improving managed care plans.

Medicare Advantage plans and Medicaid managed care organizations are growing at a rapid pace, but various regulations make it more difficult to look at cost and quality relative to their traditional, fee-for-service counterparts. In some instances, there is nearly a two-year delay in the release of important quality statistics, which it makes it nearly impossible for providers to see how improvement methods have worked.

AHCA urged CMS to release managed care data in public use files, require that claims data and Minimum Data Set data is released in a timelier manner, and lower the price point for claims data to make it more widely available. Additionally, AHCA advised the committee members to begin work on legislation that would incentivize implementation of health information technology for post-acute care providers, a step that has already been taken for hospitals and physician groups.

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