Medicare Advantage denial rates have reached 17%, more than double traditional Medicare. Here is what is driving the gap, and what practices with MA volume need to do about it.
September 15, 2026
No Comments
Medicare Advantage denial rates have reached 17%, more than double traditional Medicare. Here is what is driving the gap, and what practices with MA volume need to do about it.
RCM teams spend 51 to 75 hours a week working denials. The dollars are one measurement. The staff capacity you never get back is another. Here is the full labor math.
74% of provider executives now prioritize preventing denials over recovering them. Here is what actually changed, and what an operation built around prevention looks like.
Every PM and EHR vendor is being asked about AI. Before committing to an AI denial prevention roadmap, here are five questions that should shape the answer.
PM vendor churn is rarely about the software. It is about the outcomes the software drives. First-pass acceptance rate is one of the most visible outcome metrics on that list.
Every PM vendor that has built payer connectivity in-house has, at some point, calculated its true cost. Most calculate wrong. Here is the math, with the hidden costs surfaced.
When your clearinghouse partner has an outage, your customers do not blame the clearinghouse. They blame your software. Here is what platform vendors need to know about partner brand risk.
HHS opened rulemaking on the next EDI standards migration in 2025. There is no deadline yet, but the last transition (4010 to 5010) touched every PM system in the market. Here is what to plan for.
The per-transaction rate your clearinghouse quotes is misleading. Here is why cost per patient is the only pricing comparison that matters, with the math worked out.
Portal-based claim submission works for a handful of payers. It breaks around payer 15 to 20. Here is what real multi-payer submission requires, and when platforms outgrow the portal approach.