80 Premier Members Call for Medicare Advantage Changes to Address Payment Denials and Delays

*:last-child]:mb-0 [&>*:last-child]:pb-0 [&>p]:font-normal text-left [&>.prm-button-bar]:justify-start [&_.portable-text-link]:font-semibold [&_.portable-text-link]:underline [&_.prm-button-bar_a]:no-underline [&_li]:text-light-gray [&_p]:text-light-gray">

Premier and 80 of our member organizations, including large health systems, hospitals and post-acute care providers, sent a letter to newly confirmed Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, M.D., highlighting the results of a national survey of hospitals, health systems and post-acute care providers that reveal the scope of payment delays and denials by private payers. The organizations expressed serious concerns with payment delays and denials, which adversely impact patients' timely access to medically necessary care and impose unnecessary administrative and financial burdens on providers. In the letter, Premier and its members call for policy changes to the Medicare Advantage program to address the root causes of delays and inappropriate denials in claims processing, removing barriers to high-quality care.

The survey found that claims adjudication costs healthcare providers more than $25.7 billion, representing a 23 percent increase over the $19.7 billion in costs reported in the previous year. With approximately 70 percent of claim denials overturned and paid, this means that nearly $18 billion was potentially wasted arguing over claims that should have been paid at the time of submission.

Acknowledging that Premier's advocacy efforts have already influenced CMS guidance and informed the agency's Medicare Advantage rulemaking cycle, the letter underscores that more action is needed. Premier and its members urge Congress and the Administration to take the following actions to ensure timely provider reimbursement and protect patient access to care:

• Finalize laser-focused policy solutions from the Contract Year 2026 Medicare Advantage and Part D proposed rule, such as prohibiting Medicare Advantage plans from reopening approved authorizations for acute care, that improve patient experiences while minimizing additional regulatory burden.
• Take enforcement action against Medicare Advantage plans that fail to abide by the coverage rules of Medicare, which has included coverage of post-acute skilled nursing services since Congress created the Medicare program in 1965.
• Collect and make public both:
  • The percentage of payment denials and delays by CMS-regulated health plans that are generated by payer-owned and affiliated providers versus contracted providers; and
  • The percentage of claims that are denied due to incomplete documentation by providers.
• Develop policy solutions that unleash innovation to technology-enable current documentation, prior authorization and claims processing processes that are labor- and resource-intensive and highly susceptible to human error.

  Download:

  CMS Letter on Payment Delays and Denials Data April 2025