The warning was shot across the bow of Medicare Advantage Organizations (MAOs). The U.S. Department of Health and Human Services (HHS) Office of Inspector (OIG), in a report to the Centers for Medicare & Medicaid Services (CMS) raised concerned that MAOs could be denying prior authorizations requests in an attempt to increase profits.
CMS agreed to the report and, on Aug. 3, issued new guidance on the appropriate use of MAO clinical criteria for medical necessity reviews along with numerous revisions.
Reporting on this developing story during the next live edition of Monitor Mondays will be Dennis Jones, administrator of patient financial services for Montefiore Nyack Hospital.
Other segments will include these instantly recognizable broadcast segments:
- The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.
- Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
- SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.
- Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
- Legislative Update: Substituting for Matthew Albright, will be Cate Brantley, legislative affairs analyst for Zelis. Brantley will report on current healthcare legislation.