Rising Medicare Advantage Prior Authorization Denial Rates Impact Home Health

The growing rates of prior authorization denials under Medicare Advantage (MA) plans have raised concerns for home health providers. According to a recent analysis, MA plans have shown a marked increase in these denials, which complicates access to timely care and may lead to delayed services for patients.

As MA plans continue to expand their reach, understanding the nuances of each plan’s prior authorization process is crucial for agencies striving to avoid delays and revenue impacts. MA payers often have varying requirements and processes that differ significantly from traditional Medicare, placing an additional administrative burden on home health agencies.

Tips for Home Health Agencies to Manage MA Denial Trends:

• Thoroughly Review Plan Requirements: Each MA plan may have unique authorization requirements. Regularly update authorization guidelines for major MA payers to keep your billing and intake teams informed.
• Establish Appeals Protocols: Having a standard process for appealing denials can expedite resolution. Educate your staff on the specific appeal steps required by each MA payer.
• Leverage Data Analytics: Use analytics to identify denial trends among MA payers, helping your agency better understand common causes and implement targeted solutions.

The upward trend in prior authorization denials is expected to continue, so proactive management and staying informed on payer requirements can help agencies navigate the complexities of Medicare Advantage effectively.

For more insights, read the full analysis on the issue here.