Becker's Healthcare August 5, 2024
The report helps quantify the challenges hospital and health system leaders face in securing reimbursement from Medicare Advantage plans. Earlier this year, about half of 135 respondents in a survey of health system CFOs said they were considering dropping Medicare Advantage plans due to “onerous” authorization requirements and high denial rates. More than a dozen have already done so, as followed and reported by Becker’s since 2023.
Prior authorization is one tool MA insurers typically use to manage utilization and lower costs. This may contribute to their ability to offer extra benefits and reduced cost sharing, typically for no additional premium, while maintaining strong financial performance. While MA enrollment increased from 2019 to 2022, the timespan of KFF’s report, profitability...
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