To help clarify its final Medicare Advantage rule for 2024, the Centers for Medicare & Medicaid Services has published an FAQ providing additional guidance to Medicare Advantage plans and Medicare-Medicaid plans about prior authorization for admission to post-acute-care facilities and plans’ future use of artificial intelligence (AI), algorithms, and other software tools in their coverage criteria and utilization management practices.
The rule has broad implications for most health care providers but especially for post-acute-care providers, which the FAQ reflects by addressing major issues and long-running challenges for such providers, including prior authorization for discharge from acute-care hospitals into post-acute care, the use of internal coverage criteria by Medicare Advantage plans, how CMS will enforce these new standards, and more. Of particular interest to post-acute-care providers are questions on denial of prior authorization for admission to post-acute care, denial of payment after approval of prior authorization, and how CMS plans to enforce the regulation’s requirements.
Find the complete FAQ here.