Healthcare Finance News November 6, 2023
Lawmakers are concerned that CMS’ 2024 final Part C and D rule may not adequately address MA plans’ increased reliance on AI.
Democratic lawmakers in the U.S. House of Representatives have penned a letter to the Centers for Medicare and Medicaid Services, asking the federal agency to analyze artificial intelligence use in Medicare Advantage plans with an eye toward reducing claims denial rates.
In particular, representatives are concerned that CMS’ 2024 final Part C and D rule, which establishes new prior authorization requirements, may not adequately address MA plans’ increased reliance on artificial intelligence to guide coverage decisions.
Most items and services in traditional Medicare are not subject to prior authorization and instead are submitted to Medicare Administrative Contractors...
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