Jacobson - Medicare Advantage SNF denials (OIG OEI-09-24-00331)
An OIG report found Medicare Advantage plans overturned nearly all appealed prior-authorization denials for SNF admission. If your SNF faces MA denials, appealing often works.
The finding
A 2026 HHS Office of Inspector General report (OEI-09-24-00331) examined Medicare Advantage (MA) prior-authorization denials for skilled nursing facility (SNF) admissions. OIG found that when denials were appealed, MA plans overturned nearly all of them—raising concerns that many initial denials should never have been issued.
Why this matters for SNFs
A prior-authorization denial can delay a medically necessary SNF admission, disrupt care transitions, and cost the facility revenue. A very high overturn-on-appeal rate tells you two things:
- Initial MA denials are frequently wrong, and
- Appeals work—if you pursue them and build the record.
Practical steps when an MA plan denies SNF admission
- Appeal—don't absorb the denial. The data shows appeals frequently succeed.
- Document medical necessity thoroughly at the point of admission.
- Track each plan's prior-auth and appeal deadlines.
- Escalate patterns. Repeated improper denials by a plan can be raised beyond the individual case.
How Jacobson PLLC can help
We help Texas SNFs and long-term care providers push back on improper Medicare Advantage denials, protect reimbursement, and resolve payer disputes.
Source: HHS-OIG, OEI-09-24-00331 (report and highlights PDF).
Grant McFarland
Super-knowledgeable blogger about healthcare law.