Large hospital systems with huge staffs can dedicate time and power to combating claims denials, the American Hospital Association says. In response, some smaller systems are beginning to reject Medicare Advantage plans. This summer season, Jason Merkley, chief government of Brookings Health System, a highly rated nonprofit hospital chain in South Dakota, stopped accepting the plans because of protection denials and pre-authorization issues. Only a small percentage of the system’s patients had Medicare Advantage plans, Merkley told NBC News, but the effort required to battle the denials was appreciable. Meanwhile, CEOs of rural nonprofit hospital systems in Arkansas, Colorado, Mississippi, Missouri, South Dakota and Texas told NBC News that Medicare Advantage plans repeatedly refuse to reimburse them for the care they provide.

This spring, Dr. Kenneth Williams needed to shut down a longtime geriatric psychiatry program that had served the space people for over eight years. Former New York Jets …