July 15, 2016

Mike Adelberg Discusses Medicare Advantage Audits, Network Adequacy in Medicare Advantage News

​Medicare Advantage (MA) organizations may want to plan for a future in which they are required by the Centers for Medicare and Medicaid Services’ to hire independent auditors to confirm that they have remediated agency concerns. As Mike Adelberg, senior director for FaegreBD Consulting, explained in Medicare Advantage News, the results of recent program audits suggest that independent auditors will no longer be limited to “the handful of MAOs that came under sanction,” and may become a broader practice. Adelberg said independent auditors could be beneficial and do not pose an “existential crisis.”

“... these independent auditors see successful practices across the industry. If they catch some things that help an MAO turn a vulnerability into a strength, that’s added value,” Adelberg said. 

Adelberg also discussed a recent Kaiser Family Foundation study on MA networks that did not find a correlation between network size and MA plan quality.

“This study is narrow, but still important, because everyone’s wondering if narrow networks map to lower quality ratings,” Adelberg said. “At least as far as this study goes, it did not find a correlation. This fuels the emerging debate about measuring network effectiveness instead of network size.” 

​The complete article is available for subscribers. 

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