GAO Report: Prior Authorization Likely Saves Money

The US General Accounting Office (GAO) last month released its report to the US Senate Finance Committee on Medicare’s use of prior authorization. Read the report.

Overall, the GAO’s analyses of actual expenditures and estimated expenditures found that estimated savings from all demonstrations through March 2017 could be as high as about $1.1 to $1.9 billion. While some attribute the savings largely to prior authorization requirements, other factors, such as a durable medical equipment competitive bidding program, may also have contributed.

The report also reveals that some physicians said they experienced challenges including difficulty obtaining the necessary documentation from referring physicians to submit a prior authorization request, although the report says that the Centers for Medicare and Medicaid Services (CMS) has created templates and other tools to address this concern.

Department of Health and Human Services neither agreed nor disagreed with GAO’s recommendations but said it would continue to evaluate prior authorization programs and take GAO’s findings and recommendations into consideration in developing plans or determining appropriate next steps.

Read the 49-page document.


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