Home Health Care News November 26, 2024
The Centers for Medicare & Medicaid Services (CMS) is proposing new limits on Medicare Advantage (MA) plans regarding prior authorization, utilization management, coverage decisions and the use of artificial intelligence (AI). These proposed changes aim to address the barriers to accessing care identified by CMS.
Data reported to CMS by MA plans show that, on average, these plans overturn 80% of their claim denial decisions when appealed. However, less than 4% of denied claims are actually appealed, indicating that many more denials could potentially be reversed through the appeals process. This data suggests that MA enrollees may not be receiving necessary care.
CMS is actively working to mitigate inappropriate prior authorization and other utilization management practices that limit access to...
Today's Sponsors
Today's Sponsor