CMS’s Test of Prior Authorization Might Deliver Substantial Savings

CMS’s Test of Prior Authorization Might Deliver Substantial Savings

In July, the Centers for Medicare and Medicaid Services (CMS) announced a six-year test of more aggressive prior authorization in Medicare’s traditional fee-for-service (FFS) program. CMS will conduct the demonstration through its Center for Medicare and Medicaid Innovation (CMMI) which was created by the Affordable Care Act (ACA). Given the large volume of services paid for by FFS (1.1 billion claims were processed in 2021) and the minimal over…