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Prior authorizations and ASCs: 11 insights for 2022

Eighty-one percent of medical groups have seen an increase in prior authorization requirements since 2020, according to a poll conducted by the Medical Group Management Association in May.

Eleven updates on prior authorizations from the last year:

1. This month, CMS removed a type of corrective lid surgery from the hospital outpatient department prior authorization list. 

2. In October, the American Association of Neurological Surgeons and the Congress of Neurological Surgeons voiced support for a Senate bill addressing prior authorizations for some patients.

3. In October, New York Gov. Kathy Hochul suspended prior authorization requirements for 30 days in an executive order to address staffing challenges in the state. 

4. In October, Humana and Boston-based Cohere Health expanded their partnership enabling a digitized prior authorization process nationwide. 

5. In September, a Texas law went into effect that allowed certain physicians in the state to bypass requiring approval from insurers for some medical procedures, treatments or drugs. Physicians who are approved 90 percent of the time for a service now receive "gold card" status and are exempt from the prior authorization process.

6. In August, CMS encouraged all Medicare Advantage organizations and Medicare-Medicaid plans to waive or relax certain prior authorization requirements amid the COVID-19 surge.

7. In August, the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery asked Congress in a letter to urge Aetna to rescind its prior authorization requirements for cataract surgery. 

8. In July, CMS forged ahead with a prior authorization requirement for cervical fusion procedures despite protest from several organizations.

9. Michigan health insurer Priority Health launched an electronic portal to streamline the preauthorization process for its members.

10. In May, the Society for Cardiovascular Angiography and Interventions stated its support of state representatives reintroducing the Improving Seniors' Timely Access to Care Act of 2021, a bill that would provide oversight of Medicare Advantage plans and improve the prior authorization process.

11. In May, the American Medical Association asked Congress to pass legislation that would reduce burdens associated with prior authorization, arguing that the policy brings increased administrative work and reduces access to care.

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