Medicare Recovery Auditors (RACs) rate of claims denials to hospitals has continued to grow, as the number of denials was up 23 percent in the most recent quarter, according to the American Hospital ...

The Office of Inspector General has released a report examining prior authorization patterns from seven managed care companies, and based on the findings is urging increased oversight of prior ...

In response to these findings, the Centers for Medicare and Medicaid Services (CMS) finalized a 2024 rule to clarify “clinical criteria guidelines to ensure people with MA receive access to the same ...

New data exposes aggressive tactics by payers for Medicare Advantage denials. Hospital CFOs are in the crosshairs of aggressive Medicare Advantage (MA) payers, who are increasingly denying claims and ...

When you are sick or in pain, the prior authorization process can be frustrating and will sometimes result in a denial. If ...

The rate of Medicare Advantage (MA) claims has escalated in recent years, prompting medical and government scrutiny of prior authorization processes that slow down care in favor of cost savings.

Dear Savvy Senior: What steps do I need to take to appeal a denied Medicare claim? — Frustrated Retiree Dear Frustrated Retiree: If you disagree with a coverage or payment decision made by Medicare, ...

Medicare Advantage insurers fully or partially denied 7.4% of prior authorization requests in 2022, an increase compared to the previous three years, according to an analysis by health policy research ...

If you need help filing an appeal, you can appoint a representative (a relative, friend, advocate, attorney or someone else ...