MedPage Today April 29, 2022
— Feds found 18% of physician payment requests that were turned down met Medicare rules
Medicare Advantage plans often denied medically necessary care to beneficiaries and payments to doctors that met Medicare coverage rules, according to a new report from the HHS Office of the Inspector General (OIG).
OIG found that 13% of prior authorization requests that were denied met Medicare coverage rules, as did 18% of physician payment requests that were turned down.
The type of care denied typically involved advanced imaging services, such as MRIs, and stays in post-acute care facilities, the report stated.
The report added that plans denied these services and requests by using clinical criteria that are not contained...
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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, OIG, Physician, Provider, Survey / Study, Trends