Advocacy & Practice Updates — Advocacy & Practice

ASRS Urges CMS to Reduce the Burden From MA Plan Chart Reviews, Rate Plans on Consumer Complaints

This week, ASRS submitted comments to CMS on the 2023 Medicare Advantage (MA) and Part D Advance Notice. The Advance Notice is an actuarial document with payment proposals for MA and Part D plans in the coming year. For MA Plans, CMS proposes an almost 10% pay increase, half of which comes from increased risk adjustment scores submitted by the plans. ASRS points out in our comments that MA plans have padded their risk scores for years based on data harvested from excessive medical record requests to physician practices and the Health and Human Services Office of Inspector General has questioned the validity of the risk data plans present to CMS. ASRS urges CMS to reduce the administrative burden on retina specialists’ practices by preventing MA plans from continuing with these record requests.
In addition, ASRS expresses support for CMS’ proposal to develop a MA plan star rating measure based on customer complaints. CMS notes that it has experienced an increase in MA plan beneficiary complaints related to deceptive marking materials MA plans use. ASRS argues that MA plans do not provide prospective members with adequate information related to step therapy and prior authorization, and therefore, a new measure to reflect how plans react when beneficiaries complain about these tactics could prompt plans to be more transparent about utilization management tactics in marketing materials.
(Published 3.2.22)