95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed

Medicare Advantage organizations (MAOs) denied 12% of requests for admission to a skilled nursing facility (SNF) in June 2024, according to a review of 19 large MAOs conducted by the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). About 18% of denied requests were appealed by beneficiaries and their treating professionals. Approximately 95% of appealed denials were overturned.

The OIG said the high overturn rate suggests that some beneficiaries may have initially been denied medically necessary care and raises concerns about denials that were never appealed.

Medicare covers short-term skilled nursing . . .