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OIG: Frequent MA prior authorization denials for long-term care hospitals, inpatient rehab
A new federal watchdog report dings the three largest Medicare Advantage insurers for frequent prior authorization denials for long-term care hospital and inpatient rehabilitation stays. | A new federal watchdog report dings the three largest Medicare Advantage insurers for frequent prior authorization denials for long-term care hospital and inpatient rehabilitation stays. Another found that initial denials among skilled-nursing facilities were near-unanimously overturned.
TL;DRAI
OIG: three largest MA insurers deny prior auth at 51-80% versus 41-42% average for long-term care and inpatient rehab. Appeal overturn rates up to 95% signal improper denials; governance gaps will likely drive regulatory tightening reshaping health system authorization frameworks.
784 words~4 min read
