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 >>
Health care leaders stepping up, take stand on vaccinations with staff
More hospital system CEOs are taking steps to end a troubling trend in vaccination hesitancy among hospital staff. Most recently,
TCH21 – Increasing Efficiencies in Behavioral Health Through Tech
It's easy to say health care's efficiency woes should and could be improved by technology. It's another thing to
New Site Launched for Rural Hospital
Before we started Groundswell Health, hospitals leaders around the country would ask us what marketing company would be a
Stepping up for Rural Hospitals
In rural health care, consumer economics and shifting demographics are fundamental challenges that the most forward-thinking hospital leaders are
Medicare Advantage Headlines >>
Kaiser Family Foundation summary of Medicare Advantage trends and updates in 2024
The Kaiser Family Foundation summarized Medicare Advantage 2024 trends and updates in enrollment. Here are the main points: Enrollment
Humana tinkers with Medicare Advantage plans amid higher costs
As more seniors advance into Medicare eligibility, Humana noted decreases in its Medicare Advantage population leading to new consideration
