Becker's Healthcare December 2, 2024
Here are three recent updates on prior authorization for ASC physicians and leaders to know:
1. In its recently proposed reforms to the Medicare Advantage and Part D programs for 2026, CMS is looking to “address concerns about the overuse of prior authorization” by clearing up definitions for internal coverage criteria, creating stricter transparency requirements for payers, ensuring enrollees are informed about their rights to appeal and collecting more data on initial coverage decisions and appeals.
2. A bipartisan group of legislators has also reintroduced the Improving Seniors’ Timely Access to Care Act, which would reform prior authorization requirements in Medicare Advantage plans. ACG has developed an advocacy tool...
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