In an article entitled “Hospitals’ Medicare Advantage problem hits an inflection point,” Becker’s Healthcare reports on hospitals’ increasing problems with collecting payments from Medicare Advantage plans, to the extent that many hospitals are planning or considering terminating their Medicare Advantage contracts.
Chip Kahn, President and CEO of the Federation of American Hospitals, was quoted in the article as telling Becker’s:
The relationship between hospitals and managed care is strained at best right now. [Insurers] are finding every way to not pay for the care that Medicare beneficiaries should receive. I don’t know how the issue gets works – we’re at a critical stage ….
Chris Van Gorder, President and CEO of Scripts Health, which terminated its Medicare Advantage contracts for its integrated medical groups in January, similarly told Beckers: “It’s become a game of delay, deny and not pay.”
The article also cited a recent Healthcare Financial Management Association survey of 135 health system CFOs, which found:
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16% of health systems are planning to stop accepting one or more Medicare Advantage plans in the next two years
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45% of health systems are considering terminating their Medicare Advantage contracts
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62% of health system CFOs report that collecting from Medicare Advantage plans is “significantly more difficult” than it was two years ago
Consistent with the experience of health systems cited in the article, Whatley Kallas, LLP’s hospital clients have increasingly experienced Medicare Advantage plans inappropriately denying and underpaying claims.
The Beckers Healthcare article is linked here.