Becker's Healthcare December 15, 2023
The Federation of American Hospitals is asking CMS to include how often Medicare Advantage plans deny claims in star ratings.
In a document shared with Becker’s Dec. 15, the federation outlined its proposal to the agency. The association of taxpaying hospitals asked CMS to add to star ratings a measure of how often Medicare Advantage plans uphold prior authorization denials after they are appealed.
“The addition of this measure will enhance CMS’s oversight of MA plans’ denial of prior authorization and payments and provide beneficiaries with needed insight to inform their decision-making,” the FAH wrote.
CMS star ratings score plans on clinical quality outcomes and member satisfaction. Plans must score four stars or higher to receive bonus...
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