Latest News
Prior Authorizations & Impact on Service Providers - RevCycle Intelligence
With the exponential growth of seniors enrolled in Medicare Advantage plans comes a downside for both plan subscribers and medical service providers. Advantage plans are, increasingly, requiring Prior Authorization of medical procedures as revealed in this RevCycle Intelligence article by Victoria Bailey. A report by the Medical Group Management Association (MGMA) found that Medicare Advantage plans are requiring prior authorizations at an increasing rate, which requires addition medical office staff, thus increasing healthcare costs. Indeed, more than three quarters of medical groups surveyed have increased or reallocated staff to handle the increasing burden of prior authorization for procedures which will be covered under Medicare Advantage plans. Further, obtaining prior authorization results in delays providing needed medical service for plan subscribers, potentially affecting that subscriber’s well being. Overall, the propensity of Medicare Advantage plans to require prior authorization Medicare procedures negatively affects both healthcare providers and Advantage plan survivors, as revealed in this RevCycle Intelligence article.
This posting is presented for informational purposes only and does not represent legal or financial guidance. Any opinions or interpretations presented are either those of the original author or, in the case of articles authored by the AMAC Foundation, are the opinions of AMAC Foundation staff, originally trained and accredited by the National Social Security Association (NSSA) and certified via the AMAC Foundation. Any links included in the article are valid on the posted date; socialsecurityreport.org cannot guarantee the duration of the links’ validity. NSSA and the AMAC Foundation and its staff are not affiliated with or endorsed by the Social Security Administration or any other governmental entity. To submit a question, visit our website (https://amacfoundation.org/services/) or email us at ssadvisor@amacfoundation.org. Because we are a non-profit organization, there is no charge for these services.