The Centers for Medicare & Medicaid Services should enhance its oversight of Medicare Advantage organization contracts and address persistent problems related to inappropriate denial of services and payment, the Department of Health and Human Services’ Office of Inspector General said in a report yesterday. When beneficiaries and providers appealed preauthorization and payment denials, MA organizations overturned 75 percent of their own denials between 2014 and 2016, OIG found. During the same period, independent reviewers at higher levels of the appeals process overturned additional denials in favor of beneficiaries and providers. “The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided,” OIG said. “This is especially concerning because beneficiaries and providers rarely used the appeals process, which is designed to ensure access to care and payment.”

Related News Articles

Headline
A report released June 17 by NORC at the University of Chicago, commissioned by the Coalition to Strengthen America’s Healthcare, found that patients enrolled…
Headline
The Centers for Medicare & Medicaid Services June 13 announced it approved state plan amendments to expand Medicaid access to care for tribal communities…
Headline
The Centers for Medicare and Medicaid Services May 30 released a notice requesting comments on a proposed Medicare Advantage service level data collection…
Headline
The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services…
Headline
The Centers for Medicare & Medicaid Services May 21 announced it will immediately begin annual audits of all Medicare Advantage plans and work to clear a…
Headline
The AHA May 21 voiced support to Senate and House sponsors of the Improving Seniors’ Timely Access to Care Act, legislation that would reduce the variation in…