CMS’ progress toward expanding its team of medical coders to audit more Medicare Advantage plans is unclear, Bloomberg reported Sept. 5.
In May, the agency said it would audit every MA plan for potential overpayments annually, in what was described as an “aggressive” plan to step up oversight. Part of the announced plan was expanding the government’s team of medical coders from 40 to around 2,000 by Sept. 1 and using “enhanced technology” to review medical records.
Since that announcement, CMS has not provided an update on meeting the Sept. 1 target, and a spokesperson would not confirm to Bloomberg if any coders have been hired. No job postings for the positions currently appear on USAJobs.gov.
A CMS spokesperson told the news outlet that “discussions regarding the scope and source of additional coder support are ongoing. The agency is evaluating operational and resource needs, including potential avenues to augment medical coding capacity.”
Insurers have been broadly supportive of the enhanced auditing plan. CMS said it would look to recover uncollected payments from past audits and complete remaining audits from 2018 to 2024. The last significant recovery of overpayments was audits of plan year 2007.
