OIG Report: MA Prior Authorization Denials Raise Concerns
Updated: May 20
Some Medicare Advantage Organization (MAO) Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. That was the title of the report of the Office of Inspector General published on April 27, 2022. (Click here to link directly to the report.) To demystify this a little: Medicare Advantage (MA) plans, also known as Medicare Part C, are managed care plans offered by private insurance carriers. When you first go on Medicare, you make the choice between Original Medicare with a Medicare supplement (MediGap) policy, or you trade in your Original Medicare for one of these managed care plans. The requirement for your doctor to get prior authorization from the insurance carrier for certain procedures or treatments is how MA plans manage your care, and their bottom line. What the OIG report found is that, "...MAOs [...] issue millions of denials each year, and CMS annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment." The report also provides recommendations on how MAOs can move to reduce the number of prior authorization denials for medically necessary care.
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