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2 bills on this topic
“Doctors, suppliers, and Medicare Advantage patients should be able to see what a plan uses to decide whether a service gets prior approval, including what records providers must submit and how patients can request the criteria for a specific service.”
2 bills on this topic
“Medicare Advantage plans should have to use secure electronic systems for prior authorization requests, responses, and records, and fax, basic forms, or nonstandard plan websites should not count.”
1 bill on this topic
“Before or when a Medicare Advantage plan takes away a doctor's prior authorization exemption, a qualified doctor in the same or a similar field should review the decision, the plan should explain the claim details and appeal steps, and HHS should provide an appeal process finished within 30 days.”
1 bill on this topic
“HHS should write Medicare Advantage prior authorization rules aimed at reducing delays and treatment interruptions for patients who are already in treatment when they join Medicare Advantage or switch from one Medicare Advantage plan to another.”
1 bill on this topic
“Medicare Advantage doctors should be able to skip prior authorization for a service when that doctor's requests for the same service were approved at least 90% of the time the year before, keep that exemption unless it is revoked or waived, and avoid later payment denials that say the exempt care was not medically necessary.”
1 bill on this topic
“The Secretary of Health and Human Services should be able to set deadlines for Medicare Advantage plans to tell patients, and doctors when appropriate, whether prior authorization requests are approved or denied, including urgent requests and real-time decisions for care that is usually approved.”
1 bill on this topic
“HHS should be able to set deadlines for Medicare Advantage prior authorization decisions, including urgent requests and possible real-time answers for services that are usually approved.”
1 bill on this topic
“CMS should post Medicare Advantage prior approval data online for each individual plan, so patients, caregivers, providers, and watchdogs can compare how plans use approvals, denials, appeals, and delays.”
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