Abstract
Prior authorization is a form of utilization managements whereby a clinician must receive insurer approval prior to rendering medical service. Medicare Advantage (MA) insurers, which now cover more than 48% of Medicare beneficiaries, commonly use prior authorization to manage spending and use for their enrollees. An estimated 99% of MA plans require prior authorization for at least some medical services.1 The use of prior authorization is also increasing in traditional Medicare. Historically, traditional Medicare did not use prior authorization requirements, but with rising health care costs, the Centers for Medicare & Medicaid Services (CMS) is reevaluating this policy and has introduced prior authorization for a small number of services (eg, home health) and certain surgical procedures (eg, anterior cervical fusion surgery).
NSTL
Amer Medical Assoc