More Than 10% Of Authorizations & Claims For Services Denied By Medicare Advantage Plans Would Be Covered Under Medicare Fee-For-Service

About 13% of denied prior authorization requests and 18% of claims denied by Medicare Advantage plans were for services that met Medicare coverage rules and would have been approved under Medicare fee-for-service, according to a review of 250 denied requests and 250 claims. The review was conducted by the Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS). For 3% of the denied requests and 6% of the denied claims that met Medicare coverage rules, the Medicare Advantage organizations (MAOs) later reversed their denials. Often the reversals occurred when a beneficiary . . .