From UnitedHealthcare backing off a gastroenterology endoscopy policy, to the American Medical Association raising concerns about the use of artificial intelligence, here are nine updates on prior authorization Becker's has reported since May 11:
1. The American Medical Association is raising concerns about the use of artificial intelligence to review claims for prior authorization. In a resolution passed at the association's annual meeting, delegates directed the association to advocate for more government oversight of AI review of patient claims.
2. Outgoing AMA President Jack Resneck Jr., MD, pointed to growing prior authorization hurdles as a significant challenge the organization is facing.
3. Prior authorization changes and paperless policies led UnitedHealth Group to cut its paper usage by 1 billion pieces, according to the company's sustainability report.
4. Administrative burdens such as prior authorization are forcing increasing numbers of physician-owned practices to seek alternative owners, the American Hospital Association said.
5. UnitedHealthcare backed off a gastroenterology endoscopy prior authorization policy and instead set up an advance notification process for non-screening GI procedures.
6. Prior authorization is the RCM task that requires the third-most subject matter expertise, according to a survey of hospital CFO and revenue cycle leaders conducted by Akasa.
7. In the first quarter of 2023, the initial prior authorization denial rate for inpatient claims for commercial payers was 3.2 percent, compared with 0.2 percent for Medicare, according to a report from Crowe.
8. Rodrigo Cerdá, MD, Independence Blue Cross' senior vice president of Health Services and chief medical officer, spoke with Becker's about the payer's pilot with Philadelphia-based Penn Medicine that allows qualifying physicians to skip prior authorization approvals needed for ultrasounds, CT scans and PET scans.
9. Nearly 90 prior authorization reform bills have been introduced in 30 state legislatures this year, according to the AMA.