Specialty Societies Submit Letter in Support of CMS Prior Authorization Proposals

On February 13, 2023, ISASS submitted comments to CMS on proposed changes released on January 30, 2023, regarding Medicare Advantage Prior Authorization rules and regulations, including audit standards, as part of a multi-society joint letter.

In the final rule, the agency announced it will strike the fee-for-service adjuster from the risk adjustment data validation audits, a tool that would have calculated a permissible level of payment errors and limited audit recoveries to payment errors above that level.

The revised rule is less strict than the initial 2018 proposed draft. At that time, CMS proposed to retroactively implement the stricter auditing standards to contracts dating back to 2011. The final rule will only apply to contracts dated from payment year 2018 and up.

The letter from the specialty society supports these rule changes and calls for CMS to take further action to reduce the harm to physicians and patients caused by Prior Authorization requirements.

To read the CMS Fact Sheet on the Final Rule, see here.

To read the Final Rule, see here.

To read the letter, see attached PDF here.

To read the AMA press release regarding the multi-society letter, see here.