For skilled nursing facilities, this data confirms that MA prior authorization — including concurrent reviews that effectively function as repeat approvals throughout a stay — represents a substantial administrative burden with direct implications for reimbursement, length of stay, and clinical staffing.
Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023
“Virtually all enrollees in Medicare Advantage (99%) are required to obtain prior authorization for some services – most commonly, higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. This contrasts with traditional Medicare, where only a limited set of services, including certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment, require prior authorization.”
— KFF, 28 January 2025
Biniek, Jeannie Fuglesten, et al. “Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023.” KFF, 28 January 2025. https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/
MA Plans’ Use of Prior Authorizations Climbs Again, Despite Heightened Pressure to Limit Tactic
“Nursing homes continue to have to pursue concurrent reviews… ‘What we’ve seen on that is those concurrent reviews are where our members are spending most of their time… there’s probably about two to three concurrent reviews for every stay an individual has,'” said Nicole Fallon, vice president of integrated services and managed care for LeadingAge.
— McKnight’s Long-Term Care News, 31 January 2025
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