RISE summarizes recent regulatory-related headlines and reports.
Report: Medicare misses self-imposed deadline to increase RADV audit staffing
The Centers for Medicare and Medicaid Services’ (CMS) aggressive plans to hire 2,000 coders by Sept. 1 to catch up and accelerate enhanced Medicare Advantage audits appear to have stalled, according to a report by Bloomberg.
CMS Administrator Dr. Mehmet Oz announced in May that the agency would fast-track audits and increase its staff of medical coders from 40 to 2,000 by Sept. 1 to manually verify flagged diagnoses during audits to ensure accuracy.
A CMS spokesperson told the publication that the government continues to have ongoing discussions regarding the scope and source of additional coder support.
HHS cracks down on health data blocking
The Department of Health and Human Services plans to increase resources to curb the practice of information blocking. In an announcement, HHS said it will take action against health care organizations block the access, exchange, and use of electronic health information.
“Unblocking the flow of health information is critical to unleashing health IT innovation and transforming our healthcare ecosystem,” said Deputy Secretary of Health and Human Services Jim O’Neill in the announcement. “We will take appropriate action against any health care actors who are found to be blocking health data for patients, caregivers, providers, health innovators, and others.”
Those who block information may face disincentives under the Medicare and Medicaid program or civil monetary penalties. For more information, read the special advisory bulletin issued by the Office of Inspector General about enforcement.
CMS: ACOs in Medicare Shared Savings Program saved $2.4B in 2024
A new report finds that accountable care organizations (ACO) in the Medicare Shared Savings Program had its highest rates of shared savings since the program began in 2012.
CMS said that 75 percent of the 476 ACOs earned performance payments totaling $4.1 billion and Medicaid saved $2.4 billion relative to benchmarks.
ACOs that achieved shared savings also reported lower utilization compared to their benchmark across many categories including hospital discharges, emergency department visits and skilled nursing facility stays.
However, 16 ACOs failed to achieve savings. CMS reported they own shared losses totaling $20.3 million.