CMS should improve prior authorization in Star Program, MGMA says

The Medical Group Management Association wants CMS to follow through with a proposal that aims to improve prior authorizations in the Star Ratings program for private Medicare plans.

In a March 2 letter to CMS Administrator Seema Verma, the group, which represents more than 55,000 medical practice administrators, said including prior authorization measures in the Star Ratings program will reduce administrative burden related to Medicare Advantage plan requirements. MGMA also said the change would improve care for Medicare beneficiaries.

"We commend CMS for recognizing the need to improve the current prior authorization environment and seeking to leverage the Star Rating Program in pursuit of that important goal," MGMA said in its letter.

In February, CMS said it will prioritize prior authorization this year in its efforts to reduce administrative burden and improve healthcare innovation. Ms. Verma specifically said the administration is looking at ways to automate prior authorization.

In its letter, MGMA suggested that CMS should have Medicare Advantage plans follow new rules from CAQH that impose two-day limits on prior authorization requests, among other recommendations.

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