Payer policy
Medicare Advantage
Private plans that replace traditional Medicare and may add prior authorization and network rules Medicare does not impose.
What it means in dermatology
Coverage must be at least equivalent to traditional Medicare, but utilization management is not, so a service payable under an LCD may still require authorization on an MA product.
Appeal timelines and levels differ from traditional Medicare, and missing an MA-specific deadline forfeits the claim.
Why it matters to your revenue
Retiree-heavy dermatology markets often run majority-MA, so treating MA as Medicare is a systematic denial source.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report — including where terms like this one are costing you money.
Request a free claims audit