Medicare Advantage Requirements for Prior Authorization & Coverage

Episode Summary:

Medicare Advantage plans come with their own set of rules when it comes to prior authorizations and coverage determinations. If you’re navigating the complex world of Medicare Advantage compliance, this episode is for you!

Jennifer and Maya are joined by Richelle Marting to break down:
✅ How prior authorization requirements differ from traditional Medicare.
✅ Key regulatory updates practices need to know.
✅ Strategies to streamline the approval process and reduce denials.

Whether you’re a provider, administrator, or compliance officer, this episode will help you stay ahead of the ever-changing Medicare Advantage landscape.

🔹 Understanding Prior Authorization in Medicare Advantage:

• The difference between Medicare and Medicare Advantage rules.
• How denials and appeals work in Medicare Advantage plans.

🔹 Regulatory Compliance & Coverage Determinations:

• The latest updates on CMS guidelines for prior authorization.
• What documentation is required for approvals.

🔹 Improving Workflow & Reducing Prior Authorization Delays:

• Strategies to speed up approvals and reduce administrative burdens.
• Best practices to avoid claim denials.

🔹 What Providers Need to Know About Coverage Policies:

• How to ensure services are covered under Medicare Advantage.
• Navigating exceptions and medical necessity requirements.

💡 Richelle’s Legal Insights: Breaking down the must-know regulations for 2025.

🛠️ Jennifer & Maya’s Practical Tips: How to optimize workflows and stay compliant.

Don’t miss Episode 8, where we welcome Robin Ingalls-Fitzgerald to discuss the importance of quality assurance in coding and audits. Learn how accuracy impacts compliance, reimbursement, and financial stability! ✅

🔔 Subscribe, leave a review, and join the conversation!

📌 LinkedIn: Jennifer McNamara | Maya Turner | Richelle Marting

Stay ahead of Medicare Advantage regulations—tune in now! 🎧