‘Bring prior authorizations into the 21st century,’ House lawmakers urge

Becker's Healthcare May 3, 2022
Andrew Cass

Four House lawmakers said it is “well past time to bring prior authorization into the 21st century,” following an HHS report on Medicare Advantage denials.

The HHS Office of the Inspector General’s report found that 13 percent of Medicare Advantage prior authorization request denials would have been approved for beneficiaries under original Medicare coverage rules. The report also found 18 percent denied payment requests met Medicare coverage rules and Medicare Advantage Organization billing rules.

“Seniors should not be denied care for routine treatments and procedures that would otherwise be covered,” Reps. Suzan DelBene, D-Wash.,...

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