Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.| Healthcare Dive
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.| Healthcare Dive
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.| Healthcare Dive
Wasteful and Inappropriate Service Reduction (WISeR) Model webpage| www.cms.gov
WHY WE DID THIS STUDY| Office of Inspector General | Government Oversight | U.S. Department of Healt...
Today, Representatives Suzan DelBene (WA-01) and Ami Bera (CA-06) led a group of 17 House Democratics in raising concerns about the U.S. Department of Health & Human Services (HHS) adding new red tape to traditional Medicare that will delay care and worsen health outcomes. This comes on the heels of an announcement a week prior where the administration took a victory lap on reducing prior authorization in Medicare Advantage. In a letter to Centers for Medicare & Medicaid Services (CMS) Admini...| U.S. Congresswoman Suzan DelBene
The report calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans.| Healthcare Dive