In a memo to Medicare Advantage (MA) plans this week, the Centers for Medicare and Medicaid Services (CMS) presented a new outline for insurers to make voluntary improvements on claims denials through a pilot program and other “key reforms aimed at accelerating care decisions and enhancing transparency for patients and providers.” 

MA plans and their processes for coverage decisions for residents in long-term care settings have been under the microscope, among other issues tied to MA.

In the memo, CMS said prior to implementing a required data collection program across all MA plans, it intends to conduct a voluntary pilot, collecting the data from a select number of MA plans in 2026.

“Beginning the collection as a pilot will allow CMS to gather lessons learned and ensure efficient and accurate reporting of data upon launch of the full-scale collection. Pilot participants would have six months to prepare for the first data submission estimated in late 2026,” the agency said.

After a few quarters of collecting data and making any adjustments as needed, CMS said it anticipates expanding the data collection to all plans in 2027.

CMS said it is now soliciting MA plans interested in volunteering for the pilot.

Read the full memo at https://tinyurl.com/wk3bddzj.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.