Medicare Advantage plan records requests: Too much?


I don't know how many of you were on the CMS provider call this week, but when they mentioned an audit of Medicare Advantage files for ACA purposes, it seemed everyone who spoke up on the call complained about the records requests they were already getting from their MA plans - describing the requests as excessive and time-consuming.

I was surprised. Do Medicare Advantage payers really make large numbers of record requests for audits and whatnot? Are they that big of a nuisance?


Roy Edroso
Part B News


  • Yes and yes!

    Shelley Gillespie

    CarePartners Health Services

    68 Sweeten Creek Road

    Asheville, NC 28803

    p: 828-277-4800, x40012

    f: 828-277-4875

  • edited June 2017
    Yes especially United Medicare

    Sent from my iPhone

    Pamela Truedson
    Practice Manager
    Neurological Specialists,PC

    Phone 203-377-5988
    Fax. 203-380-0531

  • Interesting.

    I’ve had ZERO requests for records from Medicare Advantage Plans since their inception (how many years has that been?).

    So, to put that comment in perspective
  • Yes It is almost an additional FTE to keep up with all the requests for HEDIS and the MC Risk.

    Janie Elliott CPC CEMC
    Cass Regional Medical Center
    Business Office Manager
    816-887-0315 Phone
    816-887-0315 Fax

  • Can you charge for the medical records if you release them in paper form?

  • We receive several hundred requests at a time (we are a very large group of facilities and physician practices). We have had to hire an outside vendor to assist, and like most outside vendors, they are doing a poor job (leaving out crucial records, etc.)



  • edited June 2017
    We had a terrible time with the united healthcare medicare advantage plans
    and aarp mc complete. We had our physician on a call with their medical
    director among other pertinent uhc staff to discuss the requests. We had
    been placed on an audit list and every single 99223 we billed (which was
    frequently) they asked for records then subsequently denied the line item.
    Turns out, they were using the incorrect guidelines and inexperienced
    people who didn't understand the note in order to approve the claim. It was
    a year long nightmare which included countless appeals, weekly phone calls
    with our rep and reps supervisor, and multiple faxed complaints to medicare
    for their incorrect processing and late payments.

    I believe this for sure.

    Kara L. Andrews, R.M.A.
    Practice Manager
    Gynecology of Venice, P.L.
    Orthopaedic Center of Venice, P.L.
    241 Nokomis Ave. S., Ste. A-B
    Venice, FL 34285

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  • edited June 2017
    YES AND YES! Staff time, printer time, paper and toner, faxing or postage

    Andrea Pyscher
    Office Manager
    Andrew M. LaFleur, M.D. - PLC
    phone(989) 249-9937
    fax (989) 249-9941

  • edited June 2017
    Yes, our office manager spends most of the day doing records requests. It is never ending.
    P. Dobbs RN

  • Yes, we are too and are receiving numerous requests

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor

  • edited June 2017
    We also receive many such requests. While we are on an EMR, we have not attested nor do we participate in MACRA. We do however have many patients from around the country who see us once or twice while they are visiting. At the beginning of each year (and sometimes throughout the year) we receive records requests on these patients which are time consuming and expensive to respond to. Between the Medicare Advantage requests and the HEDIS requests, it is quite burdensome.

    ~Bridget Bielinski
    Aspen Medical Care

    Sent from my iPhone. Typos courtesy of Siri.

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