Member May: Not Admitting Defeat: Overturning Rehab Admission Denials (1.25 CME) (enduring)-Not Admitting Defeat: Overturning Rehab Admission Denials

Not Admitting Defeat: Overturning Rehab Admission Denials

Video Transcription

Video Summary

The video content discussed the challenges of obtaining prior authorization for inpatient rehabilitation services and provided strategies for successful insurance appeals. The speakers emphasized the importance of documenting medical necessity and functional need for patients in the medical record. They also discussed the use of expedited appeals for urgent or emergent cases. Examples of successful appeals were provided, and tips for writing effective appeal letters were shared. The speakers encouraged proactive advocacy and education for patients and families, and they discussed the potential impact of changes to Medicare Advantage in the future. Overall, they emphasized the importance of understanding insurance coverage rules and regulations and not accepting denials without going through the appeal process.

Keywords

prior authorization

inpatient rehabilitation services

insurance appeals

medical necessity

functional need

expedited appeals

successful appeals

appeal letters

proactive advocacy

patient education

Medicare Advantage