AHA Spotlights Major Concerns with MA Plans
TL/DR –
The American Hospital Association’s (AHA) 2024 Rural Advocacy Agenda is targeting Medicare Advantage plans over issues related to payments and prior authorization procedures. AHA’s President and CEO, Rick Pollack, has voiced concerns about administrative workload, delayed payments, and denial of claims that impact patient care. The AHA advocates for cost-based reimbursements from Medicare Advantage plans, improvements in prior authorization procedures, and policy changes that support rural healthcare services.
Medicare Advantage Plans Under Fire by 2024 Rural Advocacy Agenda
The 2024 Rural Advocacy Agenda of the American Hospital Association (AHA) has expressed concerns over Medicare Advantage (MA) plans. The AHA criticizes the burden of prior authorization procedures and payments on providers.
AHA President and CEO Rick Pollack announced at the annual Rural Health Care Leadership Conference that the association aims to ensure prompt MA payments to hospitals and tackle delays that affect patient care.
Pollack noted that the substantial growth in MA enrollment and the lack of infrastructure in rural hospitals to challenge claims delays and denials is harming hospital reimbursement.
The AHA is pushing for cost-based reimbursements from MA plans, especially for critical access hospitals (CAHs), as a larger chunk of their revenue is subject to negotiated rates in MA plans.
Travis Robey, the AHA’s VP of political affairs, emphasized that failing to provide cost-based reimbursements to CAHs is a breach of Medicare’s promise, given the increase of beneficiaries in rural areas enrolled in MA plans.
Improvements in Payment and Prior Authorization Needed
A report by the Medicare Payment Advisory Commission recommends an increase in Medicare payments to hospitals following all-time low hospital margins in 2022.
The CMS has issued a final rule requiring MA plans and other public health insurance programs to respond more promptly to prior authorization requests. The AHA has called for additional action to streamline and improve this rule.
Shannon Wu, the AHA’s senior associate director of payment policy, stated that the AHA is monitoring how plans comply with new 2024 Medicare payment regulations. These regulations prevent MA plans from denying coverage of services that traditional Medicare provides, improve behavioral health, and tighten MA marketing rules.
Making Appeals to Legislators
Despite the slim chance of major health care legislation passing during an election year, Pollack encouraged rural hospitals to engage political candidates on pressing issues such as health care workforce shortages, protection for health care workers, and relief for small and rural hospitals.
The AHA launched the “We Care, We Vote” initiative to equip hospitals with resources to understand and prepare for the election, although the AHA does not endorse any presidential politics.
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