CMS: Medicare Advantage Plans Can Use AI Tools To ‘Assist’ but Not Terminate Post-Acute Care Stays

Skilled Nursing News February 8, 2024
Amy Stulick

The Centers for Medicare & Medicaid Services (CMS) is placing limits on the use of artificial intelligence (AI) tools in denials of claims related to Medicare Advantage plans, and adding more guidance to health care providers on post-acute care admissions.

The agency issued an FAQ Tuesday to address concerns related to coverage criteria and utilization management requirements in a final rule detailing policy and technical changes to the Medicare Advantage program, originally issued in April of last year. It appears that CMS sent the FAQ directly to MAOs and Medicare-Medicaid plans.

Guidance on AI and algorithm use by MA plans was highlighted in the CMS memo. It also addressed admission denials by these plans despite physician-ordered post-acute care and the...

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