The Office of the Inspector General recently issued a report showing that Medicare Advantage plans inappropriately denied 18 percent of claims and 13 percent of prior authorizations that traditional Medicare would have covered. (“Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” bit.ly/3IwWgkA.) The Medicare Advantage Plans did this through more restrictive medical policies, requiring higher levels of documentation, poor training of claim/appeal staff, and poor software that caused erroneous claim denials.
I want to highlight a related issue that doesn’t get enough attention: the mishandling of noncovered services.
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