Medicare Advantage enrollment has been on the rise, despite challenges faced by health systems with delayed and denied coverage. This trend has led to some health systems opting to drop contracts with private plans, while others are developing partnerships with more reliable payers. According to KFF, Medicare Advantage enrollment increased 8%, or 2.3 million beneficiaries, in the last year.

However, this growth has not come without its challenges. Health systems have struggled with inconsistent reimbursement and denials from Medicare Advantage plans, which has resulted in a 28% drop in hospital cash reserves. In fact, Medicare Advantage denials rose almost 56% for the average hospital from January 2022 to July 2023, according to a joint report by the American Hospital Association and Syntellis.

One health system that has experienced these challenges is UNC Health. The system’s CFO, Will Bryant, spoke during a panel at the Becker’s 11th CEO+CFO Roundtable about the need for better communication and partnerships between payers and health systems to develop mutually beneficial solutions without interference from CMS or other regulatory bodies.

Bryant expressed hope that future payer-provider partnerships will help solve the problems that have arisen over the last 30-plus years and improve patient care and outcomes. In response to these challenges, CMS is proposing more regulations to address the issue. 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.

Overall, it appears that while Medicare Advantage enrollment is on the rise, there are still many challenges facing health systems when working with these plans. It will be interesting to see how these proposed regulations will impact patient care and outcomes moving forward.

In conclusion, Medicare Advantage enrollment is increasing as more people become eligible for Medicare but it comes with its own set of difficulties such as delayed and denied coverage which results in decreased revenue for hospitals leading them to drop contracts with private plans or opt for better partnerships with reliable payers like UNC Health did.

By Editor

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