A report from the inspector general’s office of the Department of Health and Human Services uncovered delayed access or denials to seniors who should qualify for Medicare Advantage. According to the office, annual audits have found “widespread and persistent problems related to inappropriate denials of services and payment.”
Prior authorization cases that were turned down were often because of lack of documentation or not following protocol to be approved (such as getting an X-ray before an MRI). Human error played a part in denied payment issues for a simple processing error.
The office made recommendations to CMS, which oversees Medicare Advantage, to issue new guidance for the insurers and take additional steps to review system errors.
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