CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
Consumer advocates and providers express shared worries about inadequate regulations and the plans’ denial-and-delay tactics. Criticism focuses on prior authorization hurdles, low reimbursements, and a lack of transparency.
It’s the rare issue where consumer advocates and nursing home providers are in near lockstep, but on this they passionately agree: Improved rules for Medicare Advantage plans made over the last several years haven’t gone nearly far enough in creating a program that ensures adequate access to high-quality care for seniors.
The Centers for Medicare & Medicaid Services, prompted by a wave of consumer complaints and stinging federal investigations, has worked since 2022 to limit the runaway use of prior authorization, give consumers better appeals rights, and make MA insurers’ routine business practices more transparent.
But providers beaten down by the plans’ paperwork inundation and often low-pay, high-pressure contracts, and patient advocates worry whether the new administration will keep the heat on those plans or fully implement proposals pitched by the Biden team late last year.
Berklan, J. M. (2025, February 21). With Medicare Advantage at a crossroads, will regulators keep plans’ unpopular deny-and-delay tactics in check? . McKnight’s Long-Term Care News. https://www.mcknights.com/news/with-medicare-advantage-at-a-crossroads-will-regulators-keep-plans-unpopular-deny-and-delay-tactics-in-check/
Gain clarity on the Medicare Advantage payer rates and contract terms bogging down your team and affecting reimbursements.
