hifi-health-news: medicare prior authorization program uses ai for treatments

A Medicare pilot program that adds the need to get prior authorization for care among enrollees is raising concerns, but proponents of the program say it will cut down on unnecessary spending. Prior authorization, which is when an insurer will agree to pay for a service only after it reviews a particular case to determine if the specific service is necessary, is not currently needed for traditional Medicare members. But that could change if the pilot goes well from the governments perspective. The practice already is quite common in Medicare Advantage plans and commercial insurance. The Trump Administration now wants to use AI to identify when prior authorization will be applied to certain treatments. The program is being piloted in six states including Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. #medicare #medicarecosts #healthinsurance #priorauthorization