The Medical Group Management Association (MGMA) has issued a statement on the Center for Medicare and Medicaid Innovation's (CMMI) proposed Wasteful and Inappropriate Service Reduction prior authorization model.
"While MGMA supports tackling waste, fraud, and abuse in Medicare Fee-for-Service, we are concerned about the Center for Medicare and Medicaid Innovation's (CMMI) announcement of the Wasteful and Inappropriate Service Reduction (WISeR) model, which will expand the use of prior authorization for certain services in six states under Medicare Part B," the organization said. "Prior authorization continually ranks as the number one administrative burden facing medical groups, and one of the hallmarks of traditional Medicare has been the ability for physicians, not government, to determine what’s clinically appropriate for their patients."
The MGMA noted that HHS and CMS recently announced an industry pledge from health plans to reduce the volume of medical services subject to prior authorization and additional measures meant to alleviate this significant burden, but it also called out an apparent contradiction.
"Through MGMA advocacy efforts, we've seen several CMS rules finalized to reduce prior authorization burden in Medicare Advantage and increase transparency," it wrote. "The announcement of this Part B model seems to contradict the administration's recent commitments to ease the burden of prior authorization."
