95% of Medicare Advantage nursing facility denials get overturned

A 2024 federal watchdog report found that when Medicare Advantage enrollees appealed prior authorization denials for Skilled Nursing Facility (SNF) admission, they won 95% of the time.When an independent reviewer looks at the same cases a plan rejected and reverses the decision nearly every single time, that is not a system working correctly. It is a system producing denials that consistently fail review.