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ASCRS Recommends CMS Reduce Burden on Physicians Related to Medicare Advantage (MA) Risk Adjustment Audits and Ensure Plan Networks Include Adequate Specialty Coverage in 2019 MA and Part D Proposed Rule Comments

This week, ASCRS submitted comments on the 2019 MA and Part D proposed rule urging CMS to reduce burden on physician offices by limiting plans’ ability to conduct risk adjustment audits and ensure plan networks include specialty physicians. In recent years, ASCRS•ASOA has increasingly heard from members that some MA plans are requiring physician practices to participate in chart audits—sometimes requesting hundreds of charts on short notice—as a means of improving the plan’s own risk adjustment scores. These audits are outside of CMS-initiated audits, place an onerous administrative burden on practices, and only benefit the plan. We recommend that CMS work to curb this practice and require that plans only initiate chart audits when required to by CMS.

In addition, we expressed concern over a growing trend from MA plans to narrow their provider networks to the point beneficiaries either have no choice of in-network providers, or even have no in-network providers treating certain diseases. We recommend CMS include a metric for network adequacy as part of its Star Ratings program evaluating MA plans to ensure beneficiaries are aware of the plan’s coverage of specialists and continue to access the care they need.

We are also joining with the Alliance of Specialty Medicine in comments on this proposed rule.