GAO: CMS Must Develop Plans, Validate Medicare Advantage Data

September 3, 2014 in News

CMS needs to fully develop plans for leveraging data collected on services used by Medicare Advantage beneficiaries to take full advantage of the information, according to a Government Accountability Office report, Health Data Management reports.

CMS began collecting MA encounter data in January 2012. CMS has said it plans in 2015 to use diagnoses from both encounter data and risk adjustment data to determine payments to MA organizations.

Report Findings

The GAO report found that the agency has not taken appropriate actions, such as performing statistical analyses, to guarantee that MA encounter data are complete and accurate (Slabodkin, Health Data Management, 9/3).

The report stated, “Until CMS determines that encounter data are sufficiently complete and accurate to be used for risk adjustment and other intended purposes, the potential benefits of using these data will be delayed” (Murphy, EHR Intelligence, 9/3).

In addition, the report noted that CMS has not yet created timeframes or detailed plans on how it will use the encounter data for other purposes (Health Data Management, 9/3).

GAO wrote, “Deciding how the data are to be used influences which data elements need to be collected and, in turn, the extent of data reporting. However, CMS has yet to develop specifics on how or when it will use encounter data for a variety of program management purposes.”


GAO recommended that before CMS use encounter data it should:

  • Establish detailed plans and timeframes for how the data will be used in all intended purposes; and
  • Take all the necessary actions to validate the data, such as performing statistical analyses, reviewing medical records and providing updated information to MA organizations on findings (EHR Intelligence, 9/3).
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