Wed. Dec 6th, 2023

Medicare Advantage enrollment is on the rise, but health systems are facing challenges with these plans. According to a report by the American Hospital Association and Syntellis, denials for Medicare Advantage increased almost 56% for the average hospital from January 2022 to July 2023. This has resulted in a significant drop in hospital cash reserves, leading some systems to opt out of contracts with private plans.

Despite these challenges, Medicare Advantage enrollment has been increasing at an impressive rate. In the last year alone, KFF reported that enrollment increased by 8%, or 2.3 million beneficiaries. Some health systems, like UNC Health, have found it difficult to work with Medicare Advantage plans that deny coverage to patients. This has led to partnerships with more reliable payers and a potential contraction with Medicare Advantage plans that do not align with their goals.

Will Bryant, CFO of UNC Health, expressed his concern during a panel at the Becker’s 11th CEO+CFO Roundtable about the need for better communication and partnership between health systems and payers. He believes that future payer-provider partnerships will help address the issues that have arisen over the last few decades.

In response to these challenges, CMS is proposing new regulations aimed at improving communication and partnership between health systems and Medicare Advantage plans. These regulations include prohibiting volume-based bonuses to third-party marketing organizations and requiring health plans to provide notice to enrollees about any supplemental benefits changes made mid-year.

While there are still challenges associated with working with Medicare Advantage plans, many health systems see opportunities in this growing market segment. As more people become eligible for Medicare, insurers will continue to look for ways to increase enrollment while addressing concerns around coverage denials and reimbursement inconsistencies.

Overall, it’s clear that there is room for improvement when it comes to working with Medicare Advantage plans. However, as long as both providers and payers remain committed to finding solutions that benefit everyone involved, progress can be made towards a more effective healthcare system for all Americans.

By Editor

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