Fed up with claim denials for inpatient admissions by Medicare Advantage (MA) plans months after they were approved, Self Regional Healthcare in Greenwood, S.C., complained to the CMS regional office in Atlanta.
“We started sending information to CMS saying that if the Medicare Advantage plans do concurrent review and authorize inpatient care, we have every right to expect payment,” said Roy Baker, M.D., medical director of case management. Otherwise, the hospital should have the right to hold the beneficiary liable for the hospital stay. That had an impact. “CMS cares about beneficiaries. They took that to heart and [went to] the Medicare Advantage plan,” Baker said at a March 8 webinar sponsored by Intersect Healthcare and AppealMasters. “In 24 hours, a group of denials was overturned in one fell swoop. It made my CFO happy.”