“As Medicare Advantage grows, experts say, so do hard-to-fight denials,” by Kimberly Marselas, McKnight’s LTC News
“In addition to sagging Medicare Advantage payment rates, some skilled nursing providers also find themselves routinely doing battle to get paid for services they’ve already delivered. The reimbursement challenges are affecting the bottom line, and in some places, they’re starting to limit patients’ access to care, operators and billing, experts warned. Not only are many seeing managed care plans increase payment denials, some observers say they’re often doing it without justifiable cause.”
LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:
Elderlaw attorneys always claimed nearly every Medicare denial was reversible. Just appeal. But nowadays, put another entity, MCOs, in between the patient/provider and Medicare, this is what you get.
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