Lawmakers are urging the Centers for Medicare & Medicaid Services (CMS) to ban this practice, as it can negatively impact SNF residents who rely on these benefits for essential care. This issue is crucial for SNFs as they strive to ensure fair and adequate access to healthcare for their residents.
The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders is urging.
The group, led by Sen. Elizabeth Warren (D-MA) and Reps. Jerry Nadler (D-NY) and Judy Chu (D-CA), sent a joint letter to the regulator agency Tuesday, detailing their concerns and suggestions regarding the use of AI for informing or determining coverage denials for Medicare Advantage patients.
Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care.
Henreckson, J. (2024, June 28). Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care – McKnight’s Senior Living. McKnight’s Senior Living. https://www.mcknightsseniorliving.com/news/lawmakers-say-cms-should-ban-medicare-advantages-use-of-ai-to-deny-care/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
