CMS Seeks Feedback to Improve Medicare Advantage Plans

Published in Member Communities on August 03, 2022

Dan Fedor On the heels of the OIG report issued on April 28, 2022 regarding how Medicare Advantage (MA) Plans have denied approximately 13% of claims for coverage that traditional Medicare would have paid and 18% of claims for billing rules, CMS issued a notice seeking feedback to improve MA plans on July 28, 2022.

How can these MA plans improve? It's easy. Just follow the published traditional Medicare coverage and billing rules 100%. Many of these plans verbally state "we follow Medicare," but in fact, we have all seen that they don't, and trying to resolve a denial is extremely challenging as they don't make it easy (seems to be by design). With suppliers running lean due to the labor shortages, increase in cost of goods with no proportional increase to the payment rates, many suppliers don't have the resources to fight inappropriate denials and just give up. This is an unsustainable business model with unintended consequences of access issues for Medicare beneficiaries.

I understand you all are busy, but please take the time to give your feedback to this request by August 31, 2022. We at VGM and U.S. Rehab plan to submit feedback as well. This is our chance to further expose the impact these MA plans are having on the industry and how it is negatively impacting Medicare beneficiaries who are finding out that some of the plans are not "Dyn-O-Mite."

Click here to submit your feedback.

Click here to read the press release.

Click here to read the OIG report.

Dan Fedor
Director, Reimbursement and Education

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