McKnight's November 8, 2023
CHICAGO — Skilled nursing providers would get a new, improved appeals process for Medicare Advantage denials under a proposal issued late Monday by the Centers for Medicare & Medicaid Services.
The change would address one of the most significant challenges faced by nursing homes and their patients in the shift to managed care: insurers who have been able to decide single-handedly whether their own denials of care or shortened stays were appropriate.
The CMS proposal comes as MA plans find themselves under increasing scrutiny for allowing artificial intelligence and other technology to influence, and possibly dictate, coverage and the length of patient stays.
Under contract year 2025 Medicare Advantage plan changes, beneficiaries would be able to use the same appeal...
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