Medical Economics May 31, 2024
Everything you need to know about coding
Part 2: Medicare Advantage
5 strategies to address prior authorization challenges
Prior authorizations in Medicare Advantage plans are a growing problem. The news doesn’t necessarily paint a pretty picture. An investigation by the Office of Inspector General of the U.S. Department of Health and Human Services found that Medicare Advantage plans improperly applied Medicare coverage rules to deny 13% of prior authorization requests and 18% of payments. A Kaiser Family Foundation analysis found Medicare Advantage plans denied 2 million prior authorization requests in whole or in part, and although providers only appealed approximately 11%, the vast majority (82%) of those were fully or partially overturned.
Prior authorizations for Medicare Advantage are extremely challenging...
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