For newly initiated audits of MA plans, CMS will audit all eligible MA contracts for each payment year. Additionally, for audits already initiated, CMS will expedite the completion of audits for payment years 2018 through 2024.
AMA leaders are “eager to meet” and “serve as a resource” on how to address burdensome prior authorization, AMA executive vice president and CEO James L. Madara, MD, told Mehmet C. Oz, MD, the new administrator of the Centers for Medicare & Medicaid Services (CMS), in a recent letter.
The bill contains measures directly responding to high-profile public scrutiny of the insurance industry over the past year on issues including prior authorization and proposed time limits on the use of anesthesia.
As an emergency room physician, I know that time is one of a medical professional’s most vital resources. You could have a great doctor and a solid treatment plan, and catch the disease at its very first symptom, and still have medical complications because an insurance company denied the prior authorization claim.
Some lawmakers in New York are calling for increased transparency and oversight over a controversial federal drug discount program that benefits many of the state’s larger hospitals, as a nationwide debate over prescription drug pricing intensifies.