Why CHS' CFO thinks Medicare Advantage denials have 'hit a peak'

Kevin Hammons, CFO of Franklin, Tenn.-based Community Health Systems, said that Medicare Advantage payers began denying and downgrading "significantly more claims" in the post pandemic period. 

Speaking on the health system's Feb. 21 earnings call, Mr. Hammons said that denials and downgrades occurred on the commercial side as well, "but more so in the MA space," according to a transcript from Seeking Alpha

"And we believe that kind of hit a peak," he said. "And I think it's gotten a lot more attention at the governmental levels. We've certainly been active in our discussions with legislators, with our lobbying efforts. I know the American Hospital Association, Federation of American Hospitals, they've all tried to shine a light on some of the behavior of the payers."

Mr. Hammons said that has "resulted in some movement by CMS to come out with additional guidance around their expectations." Those include the two-midnight rule and prior authorization reforms

"We have yet to see any real change that's meaningful or measurable, but having said that, we do expect there to be some favorable movement into 2024," he said. 

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