Although Medicare Advantage (MA) has been greatly beneficial for participating payer organizations, the picture is less rosy for providers, according to an analysis from the Kaiser Family Foundation (KFF). Providers must deal with a more complex policy framework when working with MA plans, resulting in an increased administrative burden and higher costs.
According to Kimberly Hartsfield, “As the number of MA plans and enrollees has soared, providers must contend with a growing number of policies and regulations. Compliance with these rules has become more complex and variable, resulting in increased claims denials and prior authorization requests for providers. Research has indicated that the administrative burden associated with MA is 1.4 to 1.5 times more onerous compared to traditional Medicare when it comes to filing claims and adhering to regulations and policies.”
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(Source: Medical Economics, June 5th, 2023)