Medicare Advantage Plans and Clinical Validation
What are people seeing with Medicare Advantage plan post-payment denials? We have seen a big increase in MA clinical validation and coding DRG validation denials. Can you share your strategies for dealing with this onslaught? Do you get authorization from your patients to act as their agents in appeal? Do you have access to the terms of your contracts with MA plans? Does anyone have knowledge of ERISA regs and how they apply to appeal rights for group MA plans?