Medscape June 30, 2022
Kerry Dooley Young

Republican and Democratic members of the House called for changes in how insurer-run Medicare plans manage the prior authorization process, following testimony from a federal watchdog organization about improper denials of payment for care.

About 18% of payment denials in a sample examined by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) either met Medicare coverage rules or the rules of the insurance plan.

As such, they should not have been denied, HHS OIG said. That was the finding of an April HHS OIG report, based on a sample of 2019 denials from large insurer-run Medicare plans.

Erin Bliss, an assistant inspector general with HHS OIG, appeared as a witness at a June...

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Topics: Congress / White House, Govt Agencies, Insurance, Medicare Advantage, OIG, Patient / Consumer, Provider, Survey / Study, Trends
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