CMS seeks to improve transparency among Medicare Advantage plans

The Centers for Medicare & Medicaid Services is seeking to improve transparency among Medicare Advantage plans, which are set to collect more than $7 trillion over the next decade.

CMS issued a request for information from the public on Jan. 25, noting that such privately managed plans now account for 50% of Medicare enrollment. The action comes amid controversies in the program, with some commercial insurers accused of improperly denying coverage for imaging and other services.

“The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions,” HHS Secretary Xavier Becerra said in an announcement. “It deprives researchers and doctors of critical data to evaluate problems and trends in patient care. Transparency is key to the Biden-Harris administration’s effort to increase competitiveness and ensure that Medicare dollars are spent on first-rate healthcare.”

CMS said it is seeking data relating to all aspects of the MA program. This includes access to care, prior authorization, provider directories and networks, supplemental benefits, and marketing. The request has an extended comment period, stretching through May 29, to gain as many responses as possible.

Organizations such as the American Hospital Association have urged CMS to hold MA plans accountable for inappropriately restricting beneficiary access to care. Insurers have faced several controversies in recent months, with some relating to imaging. In September, Cigna agreed to pay $172 million for allegedly filing false claims that lacked necessary imaging to back diagnosis codes. And in August, imaging centers and Bon Secours Mercy Health sued Anthem claiming Virginia’s largest payer had engaged in “slow pay and no pay tactics” resulting in numerous claims being arbitrarily denied.

Amid these controversies, UnitedHealthcare announced it would begin eliminating prior authorization requirements for radiology and other services in Medicare Advantage.

“In healthcare, you can’t improve what you don't know, and the way to know is with data,” Meena Seshamani, MD, PhD, CMS deputy administrator and director of the Center for Medicare, said in the announcement. “We need to have transparent Medicare Advantage data to see what’s working and what’s not working to inform our efforts to protect enrollees and drive high-quality care and competition.”

Marty Stempniak

Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic. 

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