Plans are required to report encounter data to CMS, detailing use of benefits. In the report, published Jan. 31, the GAO said the guidelines for submitting this data on supplemental benefits are not clear to plans.
Another barrier to collecting data, according to the report, is a lack of procedural codes to document the use of newer supplemental benefits like nutrition assistance.
The GAO recommended CMS clarify its guidance about submitting supplemental benefit data and add procedural codes for services that don’t yet have them.
“Having more complete information on the extent to which enrollees are using supplemental benefits, such as from the encounter data, would put CMS in a stronger position to make more informed policy decisions, consistent with its 2022 strategic framework, and meet goals it has stated related to supplemental benefits,” the agency said in the report.
Read the full report here.
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