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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.

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