6 things to know about the Medicare prior authorization pilot program

The Wasteful and Inappropriate Service Reduction initiative from CMS will take effect next year, adding prior authorization requirements to traditional Medicare. Providers in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma will pilot the new protocol.

Here are six things to know about the state of prior authorization and the upcoming program:

1. The AHA has been outspoken about delaying the program by at least six months. An Oct. 23 letter to CMS from the group outlined several recommendations for the initiative, such as establishing guardrails for AI use and altering the vendor payment methodology.
2. CMS released a provider and supplier operational guide for the program Oct. 10. The guide notes that CMS is delaying the inclusion of deep...

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