Fierce Healthcare November 3, 2023
House Democrats are pressuring Centers for Medicare and Medicaid Services to better evaluate how AI is utilized by Medicare Advantage plans, hoping to prevent eye-catching rates of denial.
In a letter released Friday and endorsed by the Center for Medicare Advocacy, Business Leaders for Health Care Transformation and other groups, 30 House members led by Rep. Judy Chu, D-Calif., and Jerrold Nadler, D-N.Y., said they are concerned about CMS’ prior authorization requirements in the final 2024 Part C and D rule.
They said MA plans’ use of AI software,managed by firms like naviHealth, myNexus and CareCentrix, has led to restrictive decisions and repeated denials, resulting in a lower quality of care for patients.
“Absent prohibiting the use of AI/algorithmic tools...
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