How Medicare Advantage claims denials weigh on providers

Modern Healthcare – Friday, June 6, 2025
By Tim Broderick

New research on Medicare Advantage claims raises concerns that lost revenue from denials could affect providers’ administrative costs and may discourage them from treating patients from groups that face higher denial rates.

The study by Harvard University researchers, of 270 million Medicare Advantage claims from 2019, found of the 17% of initial claims that were denied, 57% of those were later overturned.

The remaining denials cost providers 7% of Medicare Advantage revenue, but that cost was not borne equally across service types or patient profiles.

The study authors said one outcome is increased administrative costs because of the need to resubmit claims. Denials also could deter providers from aggressive billing practices, especially for low-value care, they noted.

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