A 2022 report from the Office of Inspector General examines the issue of prior authorization denials in Medicare Advantage plans. Here are the key findings:
- High Denial Rates: The report found that Medicare Advantage Organizations (MAOs) denied 13% of prior authorization requests, even though the services met Medicare coverage rules.
- Impact on Beneficiaries: These denials can delay or prevent beneficiaries from receiving medically necessary care, potentially leading to adverse health outcomes.
- Inappropriate Denials: Some denials were due to MAOs applying clinical criteria that were not consistent with Medicare coverage rules.
- Recommendations: The OIG recommends that the Centers for Medicare & Medicaid Services enhance oversight of MAOs to ensure that prior authorization requests are appropriately reviewed and that beneficiaries receive timely access to necessary care.
The report highlights the need for improved oversight and transparency to protect beneficiaries’ access to care.
See what else Groundswell Health is working on in healthcare >>
Atomizing Content: A Contemporary Tactic Vital to Healthcare Marketing
Creating engaging and relevant content is crucial, but an added advantage is utilizing a crew of advanced communications and marketing
Support trending upward for rural healthcare
Strain and challenges for rural hospitals persist, but awareness is growing as lawmakers prioritize funding and programs for rural health
Groundswell Health Recognized With Industry Awards
Austin-based Groundswell Health this month received industry recognition for its work in strategic healthcare communications. The healthcare-focused communications firm
Celebrating Our Hospital Partners During National Hospital Week
May 12-18 is National Hospital Week, an opportunity to recognize and celebrate the hospitals, health systems, and dedicated health care
Medicare Advantage Headlines >>
As his first cancer radiation treatment approached, his Medicare Advantage was canceled
For many patients who trusted their Medicare Advantage plans would be a helpful way to ensure care for the long
Three Health Insurers Exaggerated Medicare Advantage Enrollees’ Illnesses, Overcharging Taxpayers $140 Million
The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals. A recent
