17 fast facts on prior authorization

Below are 17 things to know on prior authorization that Becker's has reported on: 

  1. Ninety-four percent of physicians reported that prior authorization led to delays in patient care and has caused increased administrative burden.

  2. UnitedHealthcare plans to cut back on its use of prior authorization, removing procedures and medical devices from its list of services requiring signoff and reducing the number of authorizations from 13 million to 10 million annually.

  3. The American Academy of Ophthalmology commented on CMS' proposed prior authorization rule and suggested four changes.

  4. According to the most recent data from the Kaiser Family Foundation, more than 35 million prior authorization requests were submitted to Medicare Advantage plans in 2021. Of those requests, more than 2 million were fully or partially denied by Medicare Advantage insurers.

  5. UnitedHealthcare, an insurer of 45 million patients worldwide, announced changes to its prior authorization requirements for gastroenterology care, set to take effect June 1. 

  6. Sixty-four percent of physicians say that prior authorization has led to ineffective initial treatments for patients, according to a report from the American Medical Association.

  7. Physicians and staff spend an average of two whole workdays per week completing prior authorizations, taking them away from patients and patient care for about 14 hours a week, according to a report from the AMA.

  8. In December 2022, CMS issued a new proposed rule to streamline prior authorization for medical items and services.The rule would require certain payers to implement electronic prior authorization, shorten time frames for certain payers, and establish processes that make prior authorization more transparent and efficient.

  9. Seventy-nine percent of medical groups said that payer prior authorization requirements increased in the last year, according to a March poll conducted by the Medical Group Management Association.

  10. Eighty-two percent of group practice executives say prior authorization is very or extremely burdensome, according to the Medical Group Management Association's "Annual Regulatory Burden Report."

  11. The Medical Group Management Association on Sept. 12, 2022, penned a letter to CMS Administrator Chiquita Brooks-LaSure asking for certain provisions to be implemented to ease the economic burdens on physician practices, including prior authorization reform.

  12. CMS removed a type of corrective eyelid surgery from the hospital outpatient department prior authorization list Jan. 7, 2022.

  13. UnitedHealthcare now requires members to obtain prior authorization before undergoing physical and occupational therapy at multidisciplinary offices and outpatient hospitals in four states.

  14. UnitedHealth Group has decided to stop mailing prior authorization and clinical decisions to providers on paper.

  15. Thirteen percent of denied prior authorization requests made by Medicare Advantage organizations met Medicare coverage rules, according to a review conducted by the HHS Office of Inspector General released in April. 

  16. Aetna will no longer require prior authorization for cataract surgery and video electroencephalography procedures.

  17. California's Health Care Services Department issued a notice that removed prior authorization requirements for most drugs under Medi-Cal, the state's Medicaid program.

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