Politico June 4, 2024
Driving The Day
TRANSPARENCY DISADVANTAGE? As Medicare Advantage comes under scrutiny, insurers are bristling at expanding some transparency measures that providers have pushed for in the program.
The context: Medicare’s private sector alternative has come under bipartisan fire in Congress for care denials and estimates of substantial overpayment to the plans. Some lawmakers are also concerned about the use of artificial intelligence in the prior authorization process. Insurers have countered that prior authorization can curb unnecessary spending and low-value care.
The concerns come as Medicare Advantage enrollment has grown to include more than half of Medicare beneficiaries.
Earlier this year, CMS requested information about how the program can be more transparent, with a focus on data and increasing competition.
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