Foley & Lardner LLP partner Judith Waltz co-authored the American Health Law Association article, “Medicare Advantage: CMS Issues FAQs to Further Clarify New Regulations” offering insight on the Centers for Medicare & Medicaid Services’ (CMS) recently issued FAQs that explain the compliance expectations for Medicare Advantage (MA) plans with CMS’ final rule issued last year amending regulations and prior guidance.
The authors delve into CMS’ new clarity on the use of algorithms and artificial intelligence in coverage determinations, internal coverage criteria, the two-midnight rule, and prior authorization.
“With this dramatic increase in MA’s role in the coverage, delivery and payment of services to Medicare beneficiaries, as well as concerns identified by OIG and relators, it is to be expected that scrutiny of the MA programs will increase,” the authors conclude.
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