HealthLeaders Media June 7, 2023
Even for insurers, the administrative process in the private program has drawbacks that may not be worth the cost savings.
With nearly all Medicare Advantage enrollees in a plan that requires prior authorization, there are no shortage of requests and denials of those requests.
Prior authorization requirements can not only lead to medically necessary care being delayed or denied, they can also create more practice costs and administrative burden for providers.
As part of its 2024 Medicare Advantage final rule, CMS has put in place regulations to streamline prior authorization processes to avoid unnecessary denials.
Prior authorization, in theory, is intended to manage medical costs and promote efficient utilization of care, but the...