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CMS pushing private Medicare plans to shelve prior authorization requirements during pandemic


After pressure from numerous provider groups, the federal government is now urging Medicare Advantage plans to forgo prior authorization requirements during the COVID-19 pandemic.

Such policies require radiologists to check first whether an insurer covers an imaging exam or other service, often leading to paperwork, delays in care and provider burnout. The American College of Radiology said April 22 that it has strongly urged payers to waive these provisions both during and after the current crisis.

In guidance issued April 21, the Centers for Medicare and Medicaid Services said it’s received “a number of” such requests—related to prior authorization and other topics—and is urging all MA plans and Part D sponsors to consider temporarily abandoning or easing restrictions. Doing so would “facilitate access to services with less burden on beneficiaries, plans and providers,” CMS advised. “We encourage plans to consider utilizing this flexibility,” the agency added later.

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