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
The Centers for Medicare & Medicaid Services April 6 finalized updates and changes to its Medicare Advantage and Part D payment methodologies for calendar…
Headline
Sens. Jon Tester, D-Mont., and John Hoeven, R-N.D., yesterday introduced AHA-supported legislation (S. 3399) that would renew for five years a…
Headline
The Centers for Medicare & Medicaid Services should develop prior authorization measures for the Medicare Advantage Star Ratings Program to minimize care…
Headline
The Centers for Medicare & Medicaid Services today proposed changes to the Medicare Advantage and Medicare Part D programs, including implementing various…
Headline
A federal appeals court yesterday denied the administration’s request to reverse a nationwide preliminary injunction blocking a Department of Homeland Security…
Headline
The Centers for Medicare & Medicaid Services yesterday announced proposed changes to the risk adjustment model for Medicare Advantage organizations and…