Tuesday, September 17, 2019

Prior Authorization Notepad

There have been a number of intersections of CMS and prior authorization over the years.  I noted a number of them (many I wouldn't have remembered) right on my own blog. 

In July 2019, Medicare proposed preauthorization in the annual Medicare outpatient rulemaking, although for targeted surgeries like blepharoplasty and liposuction. 

In parallel this summer, on the Hill, legislation was proposed for controlling prior authorization inside Medicare Advantage (links below). 

Also on the Hill, in September 2019, a House hearing on the burdens of preauthorization on small providers.

A note pad of some relevant links below. 

2015 Budget (released March 2014) flags pre auth ideas for CMS.
http://www.discoveriesinhealthpolicy.com/2014/03/the-presidents-fy2015-budget-medicare.html

2017, United Healthcare boosts pre authorization for genetics. (This is a pop-up headline that comes and goes for various payers year by year.)
http://www.discoveriesinhealthpolicy.com/2017/06/united-healthcare-may-be-widening-pre.html

2018-2019:
AMA has a dedicated website for prior authorization & burden issues.

https://www.ama-assn.org/amaone/prior-authorization

News: AMA Says Payers Dragging Their Feet (March 2019)
https://healthpayerintelligence.com/news/ama-payers-moving-too-slowly-on-prior-authorization-fixes

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2018 OIG Report on Medicare Advantage Denial Rates Etc.

OIG Report 9/2018

Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials
https://oig.hhs.gov/oei/reports/oei-09-16-00410.asp

Trade articles on the above

https://healthpayerintelligence.com/news/oig-finds-profits-to-blame-for-denied-medicare-advantage-claims
https://revcycleintelligence.com/news/medicare-advantage-plans-overturn-75-of-their-own-claim-denials
https://www.kff.org/medicare/issue-brief/prior-authorization-in-medicare-advantage-plans-how-often-is-it-used/


February 2019 AAFP/AMA letter to Seema Verma on Prior Auth
https://www.aafp.org/dam/AAFP/documents/advocacy/legal/administrative/LT-CMS-PriorAuthMedicareAdvantage-021919.pdf
https://www.aafp.org/news/government-medicine/20190308mapriorauth.html


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April 2019:  Prior Auth Bill Coming
https://www.medpagetoday.com/practicemanagement/reimbursement/79314

June 2019:  Prior Auth Bill Imminent
https://www.medpagetoday.com/practicemanagement/reimbursement/80194

June 2019: HR 3107, DelBene et al.  Prior Auth should be less burdensome... in Medicare Advantage.
https://www.congress.gov/bill/116th-congress/house-bill/3107/text

August 2019: Hospitals burdened by prior auth, want overhaul
https://www.modernhealthcare.com/payment/hospitals-call-overhauling-medicare-advantage-prior-authorization-rules

August 2019:  Myriad says it's lost $50M due to tighter edits, especially on CYP genes, meaning Genesight; due to lab benefit managers (LBMs); similar to prior auth...
http://www.discoveriesinhealthpolicy.com/2019/08/very-brief-blog-myriad-genetics-unusual.html

August 2019:  Medicare Outpatient/OPPS Policy Introduces Prior Auth Procedures
http://www.discoveriesinhealthpolicy.com/2019/07/july-20-2019-cms-releases-cy2020-pfs.html


House Hearing September 2019

September 2019, House Committee on Small Business: Pre Auth burdens physicians.  Hearings and testimony.
https://smallbusiness.house.gov/calendar/eventsingle.aspx?EventID=2794

For the Hearing, testimony from Dr. Harari, Oncology, University of Wisconsin; from Dr. Walega, Anethesiology & Pain Management, Northwestern; Dr. Cullen, family practice, Arkansas; Dr. Rogers, dermatologist, Amer Acad Dermatology.

   House Committee Info as ZIP File
   I've put all the House Hearing testimony PDF files, agenda, and an "only here" transcript in one cloud Zip file here.

Follow up press generally about the House hearing:
Modern Healthcare, September 2019:
https://www.modernhealthcare.com/politics-policy/house-committee-throws-spotlight-prior-authorization-burden
Medpage, September 2019:
https://www.medpagetoday.com/practicemanagement/reimbursement/82104
Health Payer Intelligence (playing defense!), September 2019
https://healthpayerintelligence.com/news/payers-providers-spar-over-proposed-prior-authorization-regulation
Becker Hospital Review, September 2019
https://www.beckershospitalreview.com/supply-chain/prior-authorizations-making-it-as-difficult-as-possible-for-patients-to-get-necessary-medical-supplies.html

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In other payer-provider news, Anthem rolled out steep cuts to anatomic pathology payments, see Dark Report, July 2019, here.


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This is a brief link posting. For my regular blog see Discoveries in Health Policy.


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