Report identifies five Medicare Advantage coverages with the highest denial risk

An analysis of Medicare Advantage claims data has identified the five service categories most frequently denied by private MA plans. The list includes post-acute skilled nursing facility stays, inpatient rehabilitation, certain durable medical equipment, home health services following hospitalization, and advanced imaging for non-emergent conditions. Denial rates for these services are markedly higher than the MA plan average, often due to stringent medical necessity criteria or prior authorization requirements that exceed traditional Medicare standards. For practices with a high volume of MA patients, this requires a tactical shift: strengthen clinical documentation for these five service lines, initiate pre-service reviews for any elective imaging or DME, and prepare appeals packets in advance. The OIG has been actively investigating MA denial patterns, making payer behavior in these areas a compliance focal point.