Advancing Prior Authorization: The Evolution in CMS Regulation (Health & Beauty - Health Services)
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Item ID 132766272 in Category: Health & Beauty - Health Services
Advancing Prior Authorization: The Evolution in CMS Regulation | |
The Centers for Medicare & Medicaid Services (CMS) have embarked on a decisive move by enforcing a standard for prior authorization. In a conversation with the Senior Director of Utilization Management, we discussed the potential implementation and impact of this proposed mandate, slated for enactment in January 2026 The Predicament of Prior Authorization The process of obtaining prior authorization, also referred to as pre-approval, instills apprehension in both patients and providers. According to a 2022 survey conducted by the American Medical Association, 88% of providers expressed that the demands of prior authorization were notably high. The Medical Group Management Association (MGMA) further underscored this sentiment by ranking prior authorization as the most significant regulatory challenge for doctors. In the traditional fee-for-service payment model, prior authorization by payers is undeniably vital. Without it, there would be a surge in over-treatment, leading to discomfort for patients and financial strain on payers. This practice is not exclusive to the U.S., as prior authorization is prevalent in numerous nationalized health systems. Although the fee-for-value model theoretically negates th | |
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| Target State: California Target City : Glendale Last Update : Oct 18, 2023 6:00 AM Number of Views: 74 | Item Owner : Brian Thomas Contact Email: Contact Phone: +1 08668542714 |
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2024-09-07 (0.385 sec)