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Cigna removed 25% of medical services from prior authorization requirements. This represents more than 600 codes, and includes 100 surgical codes, nearly 200 genetic testing codes, durable medical equipment, orthoses and prosthetics and other services, said Dr. Scott Josephs, chief medical officer of Cigna Healthcare.
Revenue cycle leaders discuss the challenges they face, such as prior authorization, government regulations, payer relationships, and more.
Health insurers have come under pressure as physicians claim that the pre-authorization requirements for some procedures are restrictive and increases their paperwork. "Clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians," said Scott Josephs, chief medical officer of Cigna Healthcare. The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures.
Prior authorization is a common cost-cutting tool used by health insurers, but patients say it creates hurdles that delay or deny access to care.
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.