MS Launches Online Provider Complaint Form for Medicare Advantage Plans

The Centers of Medicare and Medicaid Services (CMS) has created an online complaint form where healthcare providers can post complaints on the basis of Medicare Advantage (MA) plans. The program will enhance accountability of the MA plan performance and, at the same time, make sure that the issues of beneficiary access and care are effectively tackled.

CMS has explained that anything to be reviewed must be beneficiary-oriented. The form must also include detailed information when it is filled in by the provider. Some of the information that is supposed to be provided includes the details of the complainant, beneficiary, provider, MA plan, a complaint summary, date(s) of service, and claim number.

Complaints that are sent are automatically directed to the Health Plan Management System (HPMS) Complaints Tracking Module (CTM). CMS will consequently examine and screen every complaint and allocate a contract number. It is important to note that since the entire process is online, the MA plans will never get a copy of the original provider complaint form.

The American Health Care Association (AHCA) was pleased by the development, and it highlighted that it has long been promoting a provider-based complaint mechanism. AHCA says that the new process will aid in identifying barriers to beneficiary access in a timely manner, and data provided by the CMS can be acted upon to identify patterns and track compliance among MA plans. AHCA is urging providers, especially skilled nursing and post-acute care environments, to utilize the form to provide details on ongoing access and care-delivery issues.

The questions that the providers may have on the new complaint process will refer to the AHCA Population Health Policy Analyst, Rohini Achal, or Nisha Hammel, Vice President of Reimbursement Policy and Population Health.