5.6M+ Medicare claims denied over 6 years & other findings from study of Medicare coverage policies

Becker's Healthcare January 6, 2022
Alia Paavola

Medicare and Medicare Advantage coverage policies resulted in more than 5.6 million claim denials between 2014 and 2019, according to a new study published in the January issue of Health Affairs.

For the study, researchers worked with Aetna and Medicare data to assess the number and cost of denied claims resulting from Medicare and Medicare Advantage coverage policies. Researchers used five years of claims data from Medicare and Aetna’s Medicare Advantage plans. The study included both inpatient and outpatient claims, but didn’t look at prior authorization denials.

Six things to know:

1. The amount of denied spending resulting from coverage policies between 2014 to 2019 was $416 million, or about $60 in denied spending per beneficiary.

2. Nearly one-third...

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