Denial patterns, appeal strategy, payer policy.

Issue 01. Post-acute Medicare Advantage denials

The OIG dropped two reports in June. Here is how to work them.

The three largest MA plans deny long-term acute care admissions at 71 to 80 percent. When providers appeal, 36 to 95 percent get overturned. CARC 50 decode behind the pattern, first-level appeal anatomy, and the policy alert for the next 90 days.