Prior authorizations not improving despite payer’s promises

The vast majority (79%) of medical groups surveyed by the Medical Group Management Association indicated that the number of prior authorization requirements had increased over the past 12 months. Only 2% said the requirements had decreased and 19% said they had stayed the same.

Since 2016, MGMA members have reported experiencing an increase in prior clearances compared to the previous year. Consider the following:

  • This percentage increased to 86% in a similar MGMA Statistical survey of May 16, 2017.
  • The most recent survey conducted before the COVID-19 pandemic in September 2019 found that 90% of health officials reported an increase in PA requirements from the previous year.

Challenges created by pre-authorizations listed by MGMA members include a lack of response or slow response from payers for approvals, increased staff time spent obtaining pre-authorizations, a lack of automation in pre-authorization processes for payers and delays in patient care due to lack of pre-authorization.

It is hoped that Congress will take action to limit payor pre-authorizations. Legislation has been reintroduced that would limit the pre-authorization requirements of the Medicare Advantage plan. the An Act to improve rapid access to care for seniors (S. 3018/HR 3173) would increase transparency around Medicare Advantage pre-authorization requirements, standardize the process for regularly approved services, ensure claims are reviewed by qualified medical personnel, and establish an electronic authorization program prior. As this bill was drafted using a set of principles agreed by plans and providers in 2018, the MGMA hopes to see it passed before the end of the year.

Previous Traumatic brain injury may increase veterans' long-term stroke risk
Next Issewal gang rape: five sentenced to life until death : The Tribune India