SNF operators face ongoing prior authorization headaches including repeat authorizations and unpaid approved claims despite CMS rules that were supposed to eliminate both.
There’s been a flurry of regulatory activity related to Medicare Advantage (MA) in the first half of this year, with many policy actions being the result of extensive advocacy efforts among nursing home organizations. However, many of the regulations – such as those related to prior authorizations for certain services – as they stand are unclear, leading to less efficacy, said Nicole Fallon, vice president of integrated services and managed care at LeadingAge.
— Skilled Nursing News, July 15, 2024
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