June 08, 2016

CMS Continues Data-Driven Approach to Optimizing Network Oversight

​The Centers for Medicare and Medicaid Services (CMS) is not slowing its efforts to capture data on provider network adequacy. The agency recently unveiled a policy that will require Medicare Advantage (MA) plans to report on mid-year provider network changes, data that could inform use of the new Network Management Module (NMM) and other emerging oversight tools. Mike Adelberg, senior director for FaegreBD Consulting, told Medicare Advantage News that the new guidance follows with CMS's continued emphasis on leveraging data to optimize network oversight.

“This is another in a string of new guidance and requirements to put CMS in a better position to regulate provider networks in a data-driven manner, and to help CMS understand how much networks fluctuate after approval,” Adelberg said. “This data will help the agency understand what is normal industry practice and, at some point, inform ways to curb outliers.”

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