Becker's Healthcare October 20, 2021
On behalf of its nearly 5,000 member hospitals and health systems, the American Hospital Association is urging CMS to revise proposed regulations around prior authorizations and address “problematic” usage of prior authorizations by certain Medicare Advantage health plans.
Prior authorizations are a process in which a provider, on behalf of a patient, requests approval from the patient’s insurer to ensure the treatment or service will be covered. This process, while designed to ensure patients are receiving care in the right setting based on efficacy and safety, can be cumbersome for providers as many plans have different requirements and submission guidelines.
To help streamline prior authorizations, CMS proposed a rule Dec. 10 called the Reducing Provider and Patient Burden...
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