Successfully Appealing Medicare
Advantage Denials

Summary:

In September 2018, the OIG reported, “Medicare Advantage Organizations (MAOs) overturned 75 percent of their own denials during 2014–16.” That raises concerns for CMS, patients, and providers on whether or not MAO plans are appropriately paying for services that they are required to provide. It also begs the question, “Are you doing everything you can to overturn your own denials from the MAOs?” Are you confused about the appeal process for MAO plans? Do you understand Par and Non-Par payer relations and their effect on the appeals process? Are you appealing on behalf of the beneficiary? For sure, there seems to be many obstacles to successfully appealing MAO denials, but you can be successful when you understand the rules of the game.

Join us as we share strategies for overcoming the biggest obstacles to successful MAO appeals. We will share what we’ve learned over the years from appealing hundreds of denials from Medicare Advantage Plans on behalf of our hospital clients. We’ll reveal payer behaviors regarding auditing and denying services and all the rules around MAO plans. And, as always, we will share proven, successful appeal strategies that you can use right away.

Learning Objectives:

• Describe how MAO plans differ from traditional Medicare
• Explain the difference between Par and Non-Par payer relationships
• List the steps in the MAO appeals process
• Outline the process to appeal on behalf of the beneficiary

Hosted by: Denise Wilson MS,RN,RRT
Vice President, Clinical Appeal Services