OIG Report Reignites Lawmakers’ Push for Action on Medicare Advantage Prior Authorization

Lawmakers are engaging in a new push to adopt electronic prior authorization in the wake of a major report of certain Medicare Advantage plans denying requests.

The Department of Health and Human Services’ Office of Inspector General (OIG) issued a report late last week that showed MA plans at times delayed or denied beneficiary access to services that meet Medicare’s coverage requirements. While the report drew a scathing rebuke from the insurance industry, several lawmakers pressed for mandated electronic prior authorization.

OIG analyzed a random sample of 250 prior authorization denials and the same number of payment denials from 15 of the largest MA insurers between June 1-7 in 2019. It found that 13% of the denials fit in Medicare’s coverage requirements and so did 18% of the denied payment requests.

Source: https://www.fiercehealthcare.com/payers/oig-report-prompts-lawmakers-clamor-swift-action-medicare-advantage-prior-authorization