Here are five updates about prior authorizations that ASCs need to know:
1. In March, insurer UnitedHealthcare announced changes to its prior authorization rules for certain GI procedures that were set to go into effect June 1. The night before changes were supposed to take effect, UHC reversed its plans, opting instead for a "gold card" program.
2. In December, CMS submitted a 134-page proposal designed to improve prior authorizations for Medicare and Medicaid patients through automating the process and improving workflows. Some surgeons are still skeptical that CMS' proposals will become reality and are waiting to see actual changes and results.
3. Payers are constantly changing prior authorization rules, keeping physicians and physician staff on their toes over what procedures may or may not be approved. Brian Gantwerker, MD, a neurosurgeon at the Craniospinal Center of Los Angeles, told Becker's he is concerned about the increase in prior authorizations and the decrease of physician reimbursement rates.
4. When Becker's asked six top physician leaders what is losing them money right now, the answer was clear — prior authorizations. As inflation increases surgical costs, the majority of physicians feel as though payers are not keeping up. Prior authorizations lose physicians time and money, and they make adequate patient care more and more difficult.
5. CMS has issued a final rule to help streamline Medicare Advantage and Part D prior authorizations. Here are five things to know, according to a CMS fact sheet.