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Medicare Advantage prior authorizations are a growing burden for physicians

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A year after feds examine delays in care, MGMA finds the situation appears worse, not better.

Administrative burdens for prior authorization are getting worse under Medicare Advantage (MA) plans.

The Medical Group Management Association (MGMA) followed up a report from a year ago to better understand an obstacle to high-quality patient care.

In April 2022, the U.S. Department of Health and Human Services’ Office of Inspector General examined how prior authorizations delayed and denied care for beneficiaries. In spring 2023, the situation appears to be getting worse.

MGMA published the report, “Spotlight: Prior Authorization in Medicare Advantage,” with findings that prior authorization contributes to:

  • Increased practice administration costs
  • Disrupted practice workflow
  • Delays and denials of necessary medical care

“With half of all Medicare beneficiaries enrolled in private Medicare Advantage plans, prior authorization reform has taken on new urgency at the federal level,” said Anders Gilberg, MGMA senior vice president of government affairs.

“Medical groups now identify prior authorization in the MA program as more burdensome than commercial insurance and Medicaid,” Gilberg said in a statement. “More needs to be done to protect beneficiaries. MGMA supports commonsense policies that alleviate onerous administrative requirements and improve the timeliness of clinical care delivery. Efforts to streamline, standardize, and ultimately reduce the volume of prior authorization demands on medical practices such as CMS’ proposed Prior Authorization and Interoperability Rule, and the Improving Seniors’ Timely Access to Care Act in Congress, will further strengthen and modernize the MA program.”

The figures are based on a survey representing 601 group practices, with 65% of respondents in independent medical practices. Among them all, 95% treat patients covered by MA and 75% reported increasing numbers of MA patients.

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