November 30, 2023 10:03 am

Medicare Advantage enrollment is on the rise, but health systems are facing increased challenges with these private plans. The number of denials and inconsistent reimbursement has resulted in a 28% drop in hospital cash reserves. Some health systems, such as UNC Health, are struggling to work with Medicare Advantage plans that deny care and have opted to drop contracts with these plans.

To address these challenges, CMS is proposing more regulations, including 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. The hope is that these regulations will lead to better partnerships and communication between health systems and Medicare Advantage plans.

According to KFF, Medicare Advantage enrollment increased 8%, or 2.3 million beneficiaries, in the last year. Despite this growth, some health systems are finding it difficult to work with these private plans due to delayed and denied coverage. This has led some systems to opt out of contracts with Medicare Advantage plans altogether.

Will Bryant, CFO of UNC Health, explained during a panel at the Becker’s 11th CEO+CFO Roundtable that health systems need better communication and partnerships with payers to develop mutually beneficial solutions without interference from CMS or other entities. He expressed hope that future payer-provider partnerships will help solve the problems that have arisen over the past few decades.

In summary, while Medicare Advantage enrollment continues to rise, health systems face challenges related to delayed and denied coverage from these private plans. These issues have led some systems to drop contracts with Medicare Advantage plans entirely. However, CMS is taking steps towards addressing these challenges through proposed regulations aimed at improving partnerships between healthcare providers and payers.

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