NAACOS Discovery Call: Using your MSSP’s Q4 files to Estimate your PY 2023 benchmark

Using your MSSP’s Q4 files to Estimate your PY 2023 benchmark

We discuss how to use the CMS benchmark estimation tool for forecasting.  For PY23 in particular, DME fraud might be a factor in your estimates.  We present our most recent, not previously published findings, regarding the timing of fraudulent claims and how it changes performance forecasting.

Among the recent findings:

  • Fraudulent claim “tests” began May-Jul’23 simultaneously on PY22 and PY23, although it was too late to count against your PY22 shared savings
  • Expect a spike of fraudulent expenses excluded from Q4 reports, due to claim cutoff dates. Fraud expenditure for some ACOs increased by over 100% during this period.
  • Fraud expenditures for PY23 may continue to increase until Apr 5, 2024, based on observed fraudulent claims lag. (CMS excludes claims that are processed after that point from PY23.)

That said, your shared savings performance is heavily dependent on the DME fraud for your ACO’s region.  We have calculated these nationwide.  If you would like to request your ACO’s regional DME fraud trend, please fill out this form: Request your ACO’s regional DME fraud

(Disclaimer: We will not be discussing CMS policy changes and related advocacy.  The content of the call is intended only to understand the impact on shared savings assuming there are no policy changes.)

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