Five Reasons Prior Authorization Is Bad for Medicare Services

CMS is seeking comment on requiring prior authorization for Medicare home health, upon which approximately 3.5 million Medicare beneficiaries depend. Prior authorization means that a patient can’t receive the care her physician ordered unless and until a government official has reviewed that order (and a lot of other paperwork besides) and given it his blessing.

Learn why CMS should rescind this proposal:

1. There is No Legal Authority for Prior Authorization for Medicare-Covered Services. CMS does not have authority to impose prior authorization for Medicare-covered services.
2. It Will Have a Negative Impact on Patient Care and Outcomes. Prior authorization will impede the timely delivery of care because physician-ordered services will have to be reviewed and approved by a bureaucrat before care can be initiated. If delays were to occur in home health, medically frail seniors would face the risk of medical crises and higher readmission rates.
3. It Will Impose Significant Financial and Administrative Burdens. Prior authorization will lead to higher costs, as patients that would otherwise be served in their home are instead referred to costlier settings, or return to hospitals.
4. Prior Authorization Will Not Reduce Fraud and Abuse. Prior authorization will not stop those bad actors who are intent on defrauding the Medicare program. Instead, such criminals will submit false records to satisfy the prior authorization rules, just as they do for CMS’ other documentation requirements.
5. Medical and Patient Advocates Want to be Part of the Solution! Home healthcare and other key stakeholders would welcome the opportunity to collaborate with CMS on the development and implementation of appropriate and targeted program integrity measures that fall within CMS’s authority and that would effectively identify and eradicate fraud and abuse without exposing patients to any risk or taxpayers to any increased cost.

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Click here to learn more about prior authorization.