Healthcare Finance News January 30, 2025
The increase in prior authorization determinations since 2020 is linked to an increase in MA enrollment, KFF says.
Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023, reflecting steady increases over the past few years as the number of MA enrollees has grown, according to a new KFF analysis.
Determinations are requests for approval that providers are required to submit before providing a service. Far fewer prior authorization reviews for traditional Medicare beneficiaries were submitted to CMS – just under 400,000 in fiscal year 2023 – though the number of people enrolled in Medicare Advantage and traditional Medicare were similar in these years.
In 2023, there were nearly two prior authorization determinations on average per Medicare Advantage...
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