Arbor Research, LLC is pleased to begin a new medical review project for the Health and Human Services (HHS) Office of the Inspector General (OIG) Office of Evaluation and Inspections.

The project is a new component to ongoing study of Medicare Advantage organizations’ use of prior authorization for post-acute care. For this new component, Arbor Research will assess denials of inpatient rehabilitation facilities and skilled nursing facilities services.

Motivated by recent findings that many denials are overturned upon appeal, the present study seeks to better understand the denials and inform how to improve the accuracy and efficiency of the health care system.

“With more than half of Medicare beneficiaries enrolled in Medicare Advantage, it is important to understand whether beneficiaries have access to skilled nursing and other rehabilitation services provided under Medicare coverage rules,” said Jeffrey Pearson, PhD, Senior Research Scientist at Arbor Research. “The present study will provide an important estimate of the accuracy of initial denials and identify opportunities for improving this part of the health care system.”

This project is part of Arbor Research’s five-year blanket purchase agreement to provide expert clinical consulting services and high-quality medical review services for planning, designing, and conducting evaluation projects regarding HHS programs such as Medicare and Medicaid. This blanket purchase agreement reflects the strength of our team, our proven expertise in health services and policy research, and our commitment to advancing program integrity and improving health outcomes for patients nationwide.