As Medicare Advantage grows, experts say, so do hard-to-fight denials

McKnight's May 19, 2022
Kimberly Marselas

In addition to sagging Medicare Advantage payment rates, some skilled nursing providers also find themselves routinely doing battle to get paid for services they’ve already delivered.

The reimbursement challenges are affecting the bottom line, and in some places, they’re starting to limit patients’ access to care, operators and billing, experts warned. Not only are many seeing managed care plans increase payment denials, some observers say they’re often doing it without justifiable cause.

“The Medicare rates are going up, but the managed Medicare, the Medicaid Advantage payment rates are coming down for the same patient,” said Maureen McCarthy, RN, BS RAC-MT, president and CEO of Celtic Consulting, a clinical operations, reimbursement and revenue cycle firm in business for more than...

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