Medicare Will Require Prior Approval for Certain Procedures

The Centers for Medicare & Medicaid Services (CMS) have announced a pilot program that will require prior approval for certain medical procedures in six states. This tactic, commonly used by private insurers, has been criticized for potentially delaying or denying necessary medical care. The pilot program will apply to certain outpatient medical procedures, including advanced imaging tests, certain radiation therapies, and some other services. Providers in the affected states will need to obtain approval from CMS before performing these procedures for Medicare beneficiaries. The goal of the program is to ensure that Medicare is only paying for medically necessary services and to reduce unnecessary spending. However, critics argue that this approach can lead to delays in patient care and create additional administrative burdens for healthcare providers. The pilot program will be implemented in Arizona, Indiana, Georgia, Kentucky, Michigan, and New Jersey. CMS plans to evaluate the program's impact on quality of care, patient outcomes, and healthcare costs before deciding whether to expand it nationwide.