Increasing prior authorization burdens for Medicare Advantage patients are contributing to increased practice administration costs, disrupted practice workflow and delays and denials of necessary medical care, according to a new survey from the Medical Group Management Association (MGMA).
Of the 601 medical practices surveyed, 95% treated MA enrollees. Ninety-seven percent of those groups reported that MA patients experienced delays or denials for medically necessary care such as prescription medicine, diagnostic tests, or medical services due to prior authorization requirements.
MA enrollment now accounts for more than half of all Medicare beneficiaries, according to a new analysis from the Kaiser Family Foundation. As MA enrollment climbs, so do prior authorization requirements, the survey found. Eighty-four percent of the practices surveyed said prior authorization requirements for MA increased in the last 12 months.
Thirty-five percent of the survey respondents said they spend “upwards of 35 minutes on an average single prior authorization request” while 76% said they have to interface with five or more “health plan proprietary web portals.”
“There are so many prior authorization requirements and half-baked portals that it is nearly impossible to keep up with the level of administration required to maintain access for the staff performing them,” an Idaho family practice surveyed said. “Every time a new prior authorization is required, it’s like starting over from the beginning, or worse.”
The survey also showed that prior authorization requirements are increasing practice costs. Sixty percent of the practices surveyed reported that “at least three different employees are involved in completing a single prior authorization request.
MA plans denied in full or in part 2 million (6%) of 35 million prior authorization requests in 2021, according to a study this year by Kaiser Family Foundation. The vast majority of the denials (1.6 million) were denied in full.
In February, CMS proposed the Prior Authorization and Interoperability rule that would establish an electronic prior authorization program, require MA plans to publicly report data on prior authorization practices and shorten the required time frames for MA plans to return prior authorization decisions.
In a March letter to CMS Administrator Chiquita Brooks-LaSure, MGMA showed encouragement toward the rule.
“We are encouraged that CMS included Medicare Advantage (MA) plans in the scope of this rule and thank the agency for addressing overdue prior authorization reform in both this proposed rule and the 2024 Part C/D proposed rule,” the organization said.
