Federal Policy
CMS Publishes Qualifying Payment Amount Audits for CareSource, Ohio SERS
CMS published two qualifying payment amount (QPA) audits on Oct. 20, covering CareSource in Indiana and the School Employees Retirement System in Ohio. The CareSource audit reviewed nearly 25,000 claims, primarily emergency and non-emergency services, while the School Employees Retirement System audit examined six air ambulance claims. Both audits covered claims from Jan. 1, 2022 through May 31, 2023, and both entities must now complete corrective actions in response to the findings.
Why it mattersPayers found out of compliance with QPA calculation requirements face mandated corrective action and increased scrutiny, signaling CMS's continued audit activity under the No Surprises Act framework that affects health plan claims-pricing methodology.