“A new watchdog report finds that Medicare Advantage encounter data often lack key information necessary to oversight.”
“The Department of Health and Human Services’ Office of Inspector General found that MA encounter data are largely missing national provider identifiers (NPIs) for the providers ordering or referring services in the claims.”
“Those data, according to the report, are crucial to tracking prescribing habits to catch any red flags as part of fraud and abuse oversight.”
“‘NPIs are critical for identifying inappropriate billing and ordering patterns among providers and investigating fraud and abuse,’ OIG said in the report. ‘Both CMS and OIG rely on NPIs for ordering providers to conduct oversight and pursue fraud investigations.’”
“OIG said previous analyses have indicated the NPI data are missing from 63% of encounter data.”
“Encounter data, and concerns about potential gaps, have been a hot topic in MA policy of late, as the Centers for Medicare & Medicaid Services (CMS) is aiming to increase how much emphasis it places on such data sets in risk adjustment…” Read the full article here.
Source: OIG warns Medicare Advantage encounter data have gaps in information critical to oversight – By Paige Minemyer, August 26, 2020. Fierce Healthcare.
