Navigating the Impact of Health Systems Exiting Medicare Advantage Plans in 2024
As of 2024, a significant number of health systems across the United States have chosen to discontinue their participation in various Medicare Advantage (MA) plans. This trend has substantial implications for both healthcare providers and patients, particularly in the realms of billing, coding, and practice management.
Key Developments:
Widespread Exits: At least 28 health systems in 21 states have ceased accepting certain MA plans this year. Notable examples include Brookings Health System in South Dakota, which stopped accepting all MA plans except Medica, and Baptist Health in Kentucky, which went out of network with UnitedHealthcare Medicare Advantage and Centene's WellCare.
Patient Impact: These decisions have affected over 1 million patients, compelling them to seek alternative coverage or face increased out-of-pocket expenses. The National Association of Insurance Commissioners has expressed concerns about potential delays in access to medically necessary services, which could result in patient harm.
Implications for Healthcare Providers:
Financial Considerations: Health systems have cited factors such as delayed reimbursements, cumbersome prior authorization requirements, and high rates of patient claim denials as primary reasons for exiting MA plans. For instance, Brookings Health System reported a 22% prior authorization denial rate for MA plans, compared to just 1% for traditional Medicare.
Operational Challenges: The administrative burden associated with MA plans can strain resources, leading to inefficiencies in practice management and potential disruptions in patient care continuity.
KZA Recommendations:
Assess Contractual Agreements: Review existing contracts with MA plans to evaluate financial viability and administrative demands. Consider renegotiating terms or, if necessary, discontinuing participation in plans that adversely affect practice operations.
Enhance Patient Communication: Proactively inform patients about any changes in network status with MA plans. Provide guidance on alternative coverage options to ensure continuity of care and minimize patient disruption
Optimize Revenue Cycle Management: Implement robust billing and coding practices to mitigate the impact of claim denials and delayed reimbursements. Regular training and audits can help maintain compliance and financial stability.
Stay Informed on Policy Changes: Monitor developments in Medicare policies and MA plan regulations to anticipate and adapt to changes that may affect practice management and patient care.
KZA remains committed to supporting healthcare providers through these transitions. Our expertise in practice management and coding can help navigate the complexities arising from changes in MA plan participation. For personalized guidance, please contact our team.
Sources:
Becker's Hospital Review,
Stateline