In support of their claims, the document group cited HHS April 2022 investigation of pre-approved use. We found that Medicare Advantage Plans improperly applied Medicare coverage rules to deny 13% of previous approval requests and 18% of payments.
Examples of medical services involved in such denials included post-acute facility stays, as well as MRIs and other advanced imaging services, the HHS Chief of Staff wrote at the time.
More than 9 in 10 doctors report delays while waiting for insurance companies to approve the treatment they need, the AMA found in a recent report. investigation.
CMS was the first to announce the proposed Medicare Advantage. change Comments are being accepted from February 1st to March 3rd. The Documentation Group urged officials to respond quickly to updates to provide reassurance to patients and providers. Remedies should only include prior approval to confirm a diagnosis or other medical criteria, not “delaying or dissuading treatment,” the society wrote. increase.
In addition, Medicare Advantage recipients must have access to the same services as traditional Medicare. Also, these plans must not deny treatment ordered by a physician based on a particular provider type or setting “unless criteria of medical necessity are not met,” they said. added.
“We strongly encourage CMS to finalize these significant changes. [Medicare Advantage] and Part D, and we look forward to continuing to work with you to ease the burden. [prior authorization] Because it relates to all care in all health insurance markets.” letter concluded.
Radiologists face the heaviest burden of pre-approval, after radiation oncology and cardiology. JAMA Health Forum Analysis found.
Other groups that signed the letter included the American College of Cardiology, the American Society of Nuclear Cardiology, the American Society for Radiation Oncology, and the American Society for Radiation Oncology.
