Prior Authorization in Fee for Service Medicare: More Follow-up

On July 8, 2025, I had a blog discussing the CMMI plan to introduce Prior Authorization into Medicare Part B.   Prior-auth companies would bid for the right to interpose their Prior Auth software between the provider and the MAC.   I noted (and you had to dig for this) that the Prior Auth companies would be paid based on charges avoided (ie, the volume of denials they could generate.)

I also noted that the PA computers were supposed to simply implement the rules for existing LCDs/NCDs, but that some of the topics to be authorized actually had no meaningful guidance at CMS.

Some follow-up a month later.

At Linked In, Brian Miller highlights the potential problems, pointing us to a new Op Ed by Donald Berwick and Andrew Ducas.

See the STAT article by Berwick & Ducas here.

See also an opinion piece by Jessica Hall at Marketwatch here.

Kerry Hannon, at Yahoo Finance, August 17 here.    

Highmark on real time POC Prior Auth (collab with Abridge, here.)    

Note that if you look at sources like CMMI leader Abe Sutton's linked in channel, there are also lots of parties weighing with strong endorsements of WISER.