Managed Healthcare Executive May 20, 2022
A recent HHS Office of Inspector General’s report found that Medicare Advantage (MA) plans inappropriately deny prior authorization requests. With MA enrollment growing, scrutiny of MA plans and their utilization management strategies is also likely to grow, according to Alina Czekai, M.P.H., of Cohere Health. Czekai argues that artificial intelligence and machine learning can improve utilization management and prevent inappropriate denials.
In April, the U.S. Department of Health and Human Services released a report from the Office of Inspector General (OIG) declaring that Medicare Advantage (MA) organizations have inappropriately denied prior authorization and payment requests for covered healthcare services. The OIG report, which has been widely covered by the New York Times and other publications, is driving renewed legislative efforts...
Today's Sponsors
Today's Sponsor