CMS Audits Raise The Bar On Patient Communication

By Brian Diaz, Director of Integrated Solutions with Health Language, part of Wolters Kluwer Health

Why payers need to engage consumer-friendly strategies now

Two converging trends are moving patient communication strategies front and center for today’s payers: Consumers are demanding greater control of their healthcare decisions; and regulatory movements are requiring better patient experiences.

The equation is simple. When consumers understand both the clinical and financial side of care delivery, they are equipped to make better decisions, ultimately leading to better outcomes and lower costs. Yet recent industry activity suggests that a notable gap still exists between the language that clinicians and payers use and what patients understand.

It’s no secret that the Centers for Medicare and Medicaid Services (CMS) has ramped up Medicare Advantage audit activity in recent years. Recent headlines placed heavy hitters such as Humana, Cigna, and Health Net in the spotlight when audits resulted in cumulative financial penalties in excess of $3.5 million and a temporary suspension from marketing to future Medicare enrollees.