Jul 27, 2026 · 25 min · 9 segments
Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders…
Ivan MitchellGuest
Daniel MarinoHost
commercial organizations just the structure overall as many of us know a lot of the systems or a few of the systems around the country have chosen not to participate in medicare advantage and there's a number of reasons for that but for the most part It seems like the predominant reasons are related to the administrative cost for hospitals and health systems as they work through pre-authorizations, as they work through these denied claims and just the.
negative impact that has been placed on patients related to the pre-authorization process, not to mention the erosion of cash flow.
Interestingly enough, the OIG came out with a study recently where they evaluated 2024 Medicare Advantage activities and the denied claims, denied rates related to that.
And what they found was over 20%, I think it was close to about 23% of pre-authorized services were denied.
But the interesting thing about that is after a period of time, when the healthcare providers went back through and appealed those, 95% were approved.
And the only thing that tells me is that we've added all of this extra cost to the system because somebody's got to work these denied claims.
And again, it just it creates inefficiencies and impacts the cash flow all the way around for health care providers and for our patients and our consumers.
commercial organizations just the structure overall as many of us know a lot of the systems or a few of the systems around the country have chosen not to participate in medicare advantage and there's a number of reasons for that but for the most part It seems like the predominant reasons are related to the administrative cost for hospitals and health systems as they work through pre-authorizations, as they work through these denied claims and just the.
negative impact that has been placed on patients related to the pre-authorization process, not to mention the erosion of cash flow.
Interestingly enough, the OIG came out with a study recently where they evaluated 2024 Medicare Advantage activities and the denied claims, denied rates related to that.
And what they found was over 20%, I think it was close to about 23% of pre-authorized services were denied.
But the interesting thing about that is after a period of time, when the healthcare providers went back through and appealed those, 95% were approved.
And the only thing that tells me is that we've added all of this extra cost to the system because somebody's got to work these denied claims.
And again, it just it creates inefficiencies and impacts the cash flow all the way around for health care providers and for our patients and our consumers.
The rest of this transcript — segmented and speaker-labeled, so you land on the exact moment something was said
Search every transcript — by keyword, by phrase, or by meaning, across every show Radar indexes
Trends — what is surging across podcasts, measured against its own baseline
Alerts — when a name you follow appears in a newly indexed episode
No account is needed to search Radar.