Becker's Healthcare February 8, 2024
New guardrails for Medicare Advantage plans’ use of AI may not be clear enough, experts told members of the Senate Finance Committee.
CMS sent a message to Medicare Advantage plans Feb. 6, clarifying how new prior authorization rules set forth by the agency apply to AI. The agency wrote that AI programs can be used to assist in coverage determinations, but it is the plans’ responsibility to “ensure that the algorithm or artificial intelligence complies with all applicable rules for how coverage determinations by MA organizations are made.”
The agency will also up its auditing of denials in Medicare Advantage plans, according to the message.
Lawmakers have urged CMS to do more to regulate the use of...
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