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FAH Letter to CMS Outlines Needed Improvements & Solutions to Prior Authorization, Other MA Issues

The Federation of American Hospitals (FAH) sent a letter to CMS Administrator Chiquita Brook-LaSure highlighting several practices of Medicare Advantage (MA) plans that are harming patient care, while also outlining steps to fix these issues. 

“Medicare Advantage plans are compromising Medicare beneficiaries by exploiting prior authorization. It is just one egregious example of several ongoing and worsening practices by MA plans that are ultimately limiting beneficiaries access to needed hospital and health care services. This also frequently results in improperly delaying or withholding payment for medically necessary services,” said FAH President and CEO Chip Kahn. “These practices have been especially problematic over the past 15 months as hospitals have focused on responding to the COVID-19 pandemic.”

The letter urges CMS to take several actions that will help patients by improving access to care and MA plan engagement with hospitals. Key recommendations include:

  • Reducing the burden of prior authorization to interfere less with patient care, save administrative costs, minimize the need for costly appeals, and better target overuse, waste, and abuse.
  • Reforming the way MA plans engage with 3rd party contractors to review claims and implementing similar oversight practices to those currently used to review Medicare fee-for-service claims.
  • Undertake enforcement actions for better network adequacy, including implementing audit protocols, including for timely discharges to appropriate post-acute care, requiring plans to demonstrate meaningful access, and an easy-to-understand Star Ratings standard for MA plans.

Click here to view letter.

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