Analyzing an emerging crisis for healthcare providers
Even as Medicare Advantage (MA) plans grow in popularity, many healthcare providers are rethinking and reworking their relationships with them. A rapid rise in prior authorization and insurance claim denials among these plans has created real financial hardship for health systems.
This report dives into:
The high resource cost of appealing and overturning denials
Medicare Advantage payer behaviors and motives
Market dynamics driving consumer trends in MA
Strategies for mitigating the rise in MA denials
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We Helped a Client Recover $3.6M through IDR
A large regional physician organization based in Tennessee with providers throughout the region and a broad payer mix was concerned about potential exposure under the Independent Dispute Resolution (IDR) process—and possible reimbursement loss across its portfolio.
Take Control of Payer Management and Contract Negotiations
Download the brief to learn how leading physician practices are addressing today’s toughest payer challenges.
Quick Takes from Healthcare Financial Management Leaders at HFMA 2026 – Part 2
