84% of group practices see increase in MA prior authorization requirements: MGMA

Eight-four percent of group practices surveyed said prior authorization requirements have increased for Medicare Advantage over the past year, while less than 1 percent said those requirements have decreased, according to a May 3 survey from the Medical Group Management Association.

MGMA's survey includes responses from executives representing 601 group practices, according to the report. The survey was conducted in March. 

Six things to know: 

1. Forty-six percent of respondents said Medicare Advantage plans were the most burdensome for obtaining prior authorization. Thirty-two percent said commercial plans were the most burdensome, followed by Medicaid (20 percent) and Traditional Medicare (4 percent). 

2. Fifty-eight percent of practices saw 15 percent or more of their patients either switch from traditional Medicare to Medicare Advantage, or from one Medicare Advantage plan to another. Eight-four percent of practices said they had to reauthorize existing Medicare-covered services for those Medicare beneficiaries who have switched plans. 

3. Sixty percent of practices said there are at least three employees involved in a single prior authorization request. 

4. Seventy-seven percent of respondents said their practice has hired or redistributed staff to work on prior authorizations due to an increase in requests. 

5. Ninety-seven percent of medical groups reported their patients experience delays or denials for medically necessary care due to prior authorization requirements. 

6. Ninety-one percent of respondents said a single stand electronic prior authorization system across all insurers would alleviate burden on their practice. 

Read the full report here

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