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Phil Moeller's avatar

If the fees involve Part A, you should not be paying for them out of pocket. Can you give me details about this situation? Thanks.

Phil Moeller's avatar

CMS announced earlier that it would be using AI for prior authorization reviews, which the commercial insurers have been doing for some time. I mentioned this in a February post: "The Centers for Medicare & Medicaid Services (CMS) has launched a six-year voluntary model that will use artificial intelligence tools and human clinical reviews to test prior authorization of OM claims in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. OM advocacy groups are skeptical that the program is voluntary or that humans will play a meaningful role in invoking prior authorization requirements."

I have not seen solid results yet from the six-state test. I will share them.

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