OIG: States not reporting accurate managed care data
By HME News Staff
Updated 9:04 AM CDT, Wed March 31, 2021
WASHINGTON - Most states did not provide complete or accurate payment data on managed care payments to the CMS Transformed Medicaid Statistical Information System (T-MSIS), which provides oversight of the Medicaid program, according to a recent report from the Office of Inspector General.
The data include the amounts paid, billed and allowed for every service provided to Medicaid enrollees, including those services provided through managed care, the primary delivery system for Medicaid.
Specifically, about half of states did not provide complete or accurate information about the amounts that managed care plans pay to providers for services. Nearly three-quarters of states provided incomplete or inaccurate information about the maximum amounts that managed care plans allow for services. More than one-quarter of states provided incomplete or inaccurate information about the amounts that providers bill managed care plans for services.
The OIG recommended that CMS review state managed care payment data in T-MSIS and ensure they have corrective action plans to improve data completeness and quality, as appropriate. Further, CMS should make public its reviews of states managed care data. Finally, CMS should clarify and expand its initiative on payment data.
CMS did not concur with any of the recommendations and said it has already set priority areas for improving the reporting of T-MSIS data and it will continue to assess how to further expand data quality improvement efforts.
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