8 updates on prior authorization

From issues with Texas' new physician gold-card rule, to 118 medical societies voicing strong support for proposed Medicare Advantage overhauls, here are eight stories about prior authorization Becker's has reported since Feb. 2:     

1. Texas' physician gold-card rule took effect in October, but providers are not seeing the results they hoped for.

2. Epic, Oracle Cerner and other EHR vendors have asked HHS to extend the public comment period for a new rule to streamline the electronic transmission of prior authorizations.

3. The Kaiser Family Foundation outlined the major changes payers face from CMS' proposed prior authorization reform. 

4. A group of 70 lawmakers is pressing CMS on further Medicare Advantage reforms as the agency considers implementing prior authorization reforms and other changes to the program.

5. A group of 118 medical societies, led by the American Medical Association, voiced strong support for CMS' proposed rule overhauling prior authorization in Medicare Advantage. 

6. Elevance Health had the highest number of prior authorization requests per Medicare Advantage member, while CVS and Kaiser Permanente had the highest rate of denials in 2021. 

7. Medicare Advantage plans fully or partially denied around 6 percent of prior authorization claims in 2021. 

8. Streamlining commercial payer prior authorization practices is one of eight priorities hospitals have for Congress this year. 

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