Regarding inpatient admissions, algorithms or artificial intelligence alone cannot be used by Medicare Advantage (MA) insurers as the basis to deny admission or downgrade to an observation stay; a patient’s circumstances must be considered against the permissible applicable Medicare coverage criteria under which MA operates.
The...
Medicare Advantage (MA) is growing in popularity with a recent survey finding nine out of 10 MA beneficiaries were satisfied with their coverage, but concerns remain that MA enrollment for low-income adults may not advance health equity in the Medicare program, a major policy initiative of the Centers for Medicare & Medicaid Services...
