Helaine Fingold Quoted in “CMS’s Large-Scale Appeals Monitoring Effort Gould Have Sweeping Stars Impact”

Medicare Advantage News

Helaine I. Fingold, a Senior Counsel in the Health Care and Life Sciences practice, in the firm’s Baltimore office, was quoted in Medicare Advantage News, in “CMS's Large-Scale Appeals Monitoring Effort Gould Have Sweeping Stars Impact,” by Lauren Flynn Kelly.

Following is an excerpt:

Specifically, audited plans that had deficiencies in appeals timeliness and other aspects of appeals processing are declared by CMS to have appeals data that lacks "integrity" explains Helaine Fingold, senior counsel in the Health Care and Life Sciences practice at the law firm Epstein Becker Green. But rather than reviewing the data reported for star ratings measurement, CMS automatically assigns such plans a score of 1 (out of 5) on these related measures, she points out. “As a result plan sponsors have been pushing back on CMS's data integrity adjustments on appeals processing measures as these fall more heavily on those plans subject to audit. … By undertaking timeliness monitoring across all plan sponsors, CMS is likely attempting to level the playing field on this issue.”