Sharon Musso

Gold carding programs are programs that eliminate or reduce prior authorization requirements for providers whose requests for prior authorization have consistently been approved and/or who have met other evidence-based criteria. In its recently published proposed rules for Medicare Advantage plans for the 2024 contract year, CMS encouraged Medicare Advantage Plans to implement gold carding programs, …

CMS ENCOURAGES MEDICARE ADVANTAGE PLANS TO USE GOLD CARDING TO ALLEVIATE PRIOR AUTHORIZATION BURDEN ON PROVIDERS Read More »

A new report released by Crowe, LLP found that Medicare Advantage plans are much more likely than other payers to deny payment for inpatient claims. The report, entitled “Who’s picking up the check,” analyzed data from more than 1,700 hospitals. It found that Medicare Advantage plans denied 5.8% of inpatient admissions in 2022 compared to …

NEW REPORT FINDS MEDICARE ADVANTAGE PLANS MORE LIKELY TO DENY INPATIENT CLAIMS THAN OTHER PAYERS Read More »