MedCity News August 19, 2024
About 7.4% of prior authorization requests submitted to MA insurers were denied in 2022, according to a recent KFF report. Of these denials, only 9.9% were appealed.
Medicare Advantage insurers received about 46.2 million prior authorization requests in 2022, up from 36.5 million in 2021, according to a recent KFF report. Of these 46.2 million requests, 7.4% (3.4 million) were fully or partially denied by MA insurers, compared to 5.8% in 2021.
KFF’s analysis used data submitted by MA insurers to the Centers for Medicare and Medicaid Services. Just about all MA enrollees have to receive prior authorization for certain services, like higher-cost services, inpatient hospital stays and chemotherapy. However, the practice has come under fire recently, with lawmakers and...
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