Medicare Advantage Denial Rates Are Rising. Here's What Practices Are Seeing.

A 2024 HHS OIG report confirmed what many family medicine providers already knew: Medicare Advantage plans deny medically necessary care at higher rates than traditional Medicare.

What this means for your practice:

• - Prior auth requirements are more aggressive
• - Retrospective denials on inpatient care are increasing
• - Appeals are worth filing — MA plans overturn a significant portion of denials when appealed

If your Medicare Advantage denial rate has crept up, it's worth doing a payer-specific denial analysis. Some plans are significantly worse than others.