CMS pushing private Medicare plans to shelve prior authorization requirements during pandemic
After pressure from numerous provider groups, the federal government is now urging Medicare Advantage plans to forgo prior authorization requirements during the COVID-19 pandemic.
Such policies require radiologists to check first whether an insurer covers an imaging exam or other service, often leading to paperwork, delays in care and provider burnout. The American College of Radiology said April 22 that it has strongly urged payers to waive these provisions both during and after the current crisis.
In guidance issued April 21, the Centers for Medicare and Medicaid Services said it’s received “a number of” such requests—related to prior authorization and other topics—and is urging all MA plans and Part D sponsors to consider temporarily abandoning or easing restrictions. Doing so would “facilitate access to services with less burden on beneficiaries, plans and providers,” CMS advised. “We encourage plans to consider utilizing this flexibility,” the agency added later.
ACR said Wednesday that it’s advising Medicare Advantage and Part D plans to also waive prior authorization rules during the “surge” of screenings expected after the pandemic.
The American College of Cardiology, American College of Surgeons and other major healthcare societies previously requested prior authorization relief from CMS in a late March letter. The Medical Group Management Association said earlier this year that it was “alarmed” by the skyrocketing costs for practices to follow insurers’ prior authorization policies. CMS chief Seema Verma had indicated in February that her agency hopes to simplify these requirements in 2020.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.