Lawmakers in the US House of Representatives have expressed their concerns over the Center for Medicare and Medicaid Services' (CMS) oversight of Medicare Advantage due to coverage denials and increased spending. The program has taken up a growing spot in the general Medicare program as of late and, according to Rep. Morgan Griffith (R-VA), “the Medicare hospital insurance trust fund is projected to be insolvent by 2028 it will continue to be important to assess how well Medicare's current payment methodology for MA is working.“
According to Robert King, “One issue is that CMS has not been detailed enough in the guidance it offers to plans on when a denial for coverage may be appropriate, panelists at the hearing said. A recent report from the OIG found that at times MA plans have delayed or denied beneficiaries' access to care that met Medicare's coverage requirements.”
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(Source: Fierce Healthcare, June 28th, 2022)