CMS To Test Prior Authorizations To Reduce Wasteful Or Inappropriate Services In Fee-For-Service Medicare

The Centers for Medicare & Medicaid Services (CMS) proposed testing a prior authorization model for Medicare Part B fee-for-service (FFS) as a tool to reduce wasteful or inappropriate services. The model targets items and services with a higher incidence of waste, fraud, and/or abusive claims, such as skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. The model excludes inpatient-only services, emergency services, and services that would pose a substantial health risk if delayed.

The stated goal is to reduce the use of items and services that may have little to . . .