6 ways to fight Medicare Advantage denials

Medicare Advantage has become the center of gravity for claim denials. In MGMA's 2026 Regulatory Burden Report, three of the top five administrative burdens practices named are tied directly to Medicare Advantage: prior authorization, claim denials and automatic downcoding. Among practices seeing patients shift into the program, 79 percent said the move has hurt their operations, and the report's single biggest burden, audits and appeals, is itself largely a Medicare Advantage phenomenon.

The next year will test practices further. CMS has begun accelerating Risk Adjustment Data Validation audits, with notices for payment years 2020 and 2021 issued in spring 2026, and plans have leaned harder on automated downcoding even as they publicly pledged to scale back prior authorization. The patient stakes are real too: care a physician ordered, and that a plan later deems necessary, is routinely delayed by a denial that should not have been issued in the first place.

There is more leverage than it might seem, and most Medicare Advantage denials are more reversible than they look. New federal deadlines give practices grounds to hold plans accountable, and appeal data consistently shows that denials which get challenged are often overturned. The practices that treat Medicare Advantage denials as a process to be worked, not a cost to be absorbed, can claw back significant revenue. Here are six ways to fight back.