Appeal Management

Physician advisor appeals Medicare Advantage denial to skilled nursing facility.

Case Study: Untapped Potential for Hospitals, Appealing MA Denials to Skilled Nursing Facilities

Appeal Management, Case Study, Discharge, Medicare Advantage / By

THE CHALLENGE LA recent report identified prior authorization request denials by Medicare Advantage Organizations (MAOs) for post-acute care to be a particular area of concern. The report, published by the Department of Health and Human Services Office of Inspector General (HHS-OIG), raised concerns that the MAOs may be inappropriately denying care, evidenced by the 95% […]

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Medicare Appeals Process Needs Changes

Medicare Appeals Process Needs to be Amended

Appeal Management, Denial Management, Medicare / By

In her recent article, “Ghosting the Medicare Provider Appeals Process,” Knicole C. Emanuel Esq. argues that the process by which denied Medicare claims are reviewed and appealed is counter to rest of the U.S. legal system. The lengthy process for addressing denied Medicare claims is multi-tiered and, until recently, hampered by a years-long backlog due

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