Healthcare Finance News March 31, 2025
The board would require that board-certified physicians make determinations about whether care is medically necessary.
Lawmakers in the House of Representatives have rolled out a bipartisan bill that would task board-certified specialists with determining the medical need of prior authorization requests.
The Reducing Medically Unnecessary Delays in Care Act would reform the practice of prior authorization in Medicare and Medicare Advantage by requiring that board-certified physicians in the same specialty are the ones making those decisions.
It would also direct Medicare, Medicare Advantage, and Medicare Part D plans to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations.
Congressman Dr. Mark Green, R-TN, sponsored the bill along with...
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