Asking Permission First Can Save Big on Medicare Services


Children are taught to always ask an adult’s permission before doing anything that’s even mildly risky, and that mindset could lead to serious Medicare savings. A recent report found that Medicare saved as much as $1.9 billion over the course of five years thanks to four programs that required physicians to get Medicare approval before providing certain services.

The so-called prior authorization programs covered everything from oxygen therapy to power wheelchairs and ran from 2012 through 2017. None of the programs are currently active, and the Government Accountability Office report recommended that Medicare renew them and expand the concept to all of Medicare.

Expanding the scope of prior authorization programs could have a decidedly negative impact on patient care and physicians, Anders Gilberg, senior vice president, government affairs, at the Medical Group Management Association, told me.

Gilberg said physicians have to spend thousands of dollars to comply with prior authorization programs.

Prior authorization programs run counter to new physician payment approaches created under the Quality Payment Program, and Gilberg said the MGMA is strongly opposed to any prior authorization expansion in Medicare.

The QPP makes physicians accountable for the total cost of their care, including referrals.

A 2017 American Medical Association survey discovered that 92 percent of physicians reported patient care delays and negative clinical outcomes as a result of prior authorization.

The GAO report recommended that Medicare renew all of its prior authorization programs and expand them to additional services that have high improper payment rates, such as inpatient rehabilitation services and skilled nursing services.

Read my story here.

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