Medicare Advantage plans denied 7.4 percent of medical professionals’ prior authorization requests, or about 3.4 million requests, according to a recent KFF analysis of 2022 data. With just 1 in 10 patients appealing these denials, prior authorization denial often means care is foregone. For Kendra Sollars and her family, a Medicare Advantage plan’s prior authorization
While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds additional delays to care that can harm both hospitals and patients. A recent Becker’s article ranked MA insurers by denial overturn rates and offered insight into which companies are the most and least likely to
Of the 38 counties in the U.S where Medicare Advantage enrollment is 75 percent or more, six are in Texas, according to analyses by the Kaiser Family Foundation. Nationwide, Medicare Advantage penetration is, on average, 54 percent, a proportion that increases each year. Starr County: 81 percent El Paso County: 76 percent Hidalgo County: 76
As Medicare Advantage plans face myriad challenges, including rising costs, negative media coverage, and increased lawmaker scrutiny, the health insurance industry is planning a major lobbying effort to boost support for the alternative to Traditional Medicare. With open enrollment beginning Oct. 15, the insurance industry hopes to avoid enrollment declines. From the article: The Medicare
A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a rising share of requests that were denied. Summary Prior Authorization Request Increase: More than 46 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2022, up from
Becker’s Hospital Review summarized a recently released report from The Wall Street Journal that found Medicare Advantage plans collected $50 billion from diagnoses added to patients’ charts between 2018 and 2021, a third of which were added during home visits – even as the Medicare Payment and Advisory Commission recommends against insurers being paid for
May 12-18 is National Hospital Week, an opportunity to recognize and celebrate the hospitals, health systems, and dedicated health care professionals delivering great care each and every day. From rural hospitals to large health systems, Groundswell Health has a front row seat to the vital work hospitals and health care professionals do every day in
By Steven Carr Communications Manager | Groundswell Health From Asimov to Heinlein to Cameron, I’ve read and watched all manner of stories about AI or machine intelligence that, to some degree, frame and inform my interest and understanding of what’s happening with AI in the real world. Amid the ongoing corporate arms race for AI
We are a team of experienced communications, marketing and public affairs executives specializing in health care.
Our unique practices are established through decades of experience in public health policy, strategic marketing, and public affairs management.
