Medicare Advantage plans have been causing challenges for health systems, particularly with delayed and denied coverage. This has led to some systems opting to drop contracts with private plans. According to a joint report by the American Hospital Association and Syntellis, Medicare Advantage denials rose almost 56% for the average hospital from January 2022 to July 2023. The data also revealed that the denials and inconsistent reimbursement led to a 28% drop in hospital cash reserves.

Despite these challenges, Medicare Advantage enrollment is on the rise, with insurers seeing opportunity as more people become eligible for Medicare. For example, UNC Health has found it difficult to work with Medicare Advantage plans that are denying care to boost their earnings. To address this issue, they have developed partnerships with more reliable payers and are considering potential contraction with Medicare Advantage plans that are not good partners.

Will Bryant, CFO of UNC Health, expressed his hope during a panel at the Becker’s 11th CEO+CFO Roundtable that future payer-provider partnerships will help solve the problems that have arisen over the last 30-plus years. He emphasized the need for better communication and partnership between payers and health systems to develop mutually beneficial solutions without interference from CMS or others.

In response to these challenges, CMS is proposing new regulations to address them. These include prohibiting volume-based bonuses to third-party marketing organizations and requiring health plans to provide a mid-year notice for enrollees about any supplemental benefits changes enacted. The aim is that these regulations will lead to better partnerships and communication between health systems and Medicare Advantage plans.

Overall, while there are challenges associated with working with Medicare Advantage plans, there is still hope for better partnerships and communication between payers and health systems in the future.

By Editor

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