Medicare Advantage Prior Authorization Requirements for Otolaryngologic Procedures in 2021

• Published in: Otolaryngology-head and neck surgery Vol. 171; no. 5; pp. 1601 - 1604
• Main Authors: Miller, Lauren E., Miller, Ashley L., Rocco, James W., Rathi, Vinay K.
• Format: Journal Article
• Language: English
• Published: England 01.11.2024
• Subjects: denial; Fee-for-Service Plans; Humans; medical necessity; Medicare Advantage; Medicare Part B; Medicare Part C - legislation & jurisprudence; Otolaryngology - legislation & jurisprudence; Otorhinolaryngologic Surgical Procedures; prior authorization; Prior Authorization - legislation & jurisprudence; revenue cycle; United States; utilization management; United States; Medicare Part B; denial; revenue cycle; utilization management; Medicare Advantage; prior authorization; medical necessity

Little is known about the extent of prior authorization requirements in otolaryngology. We performed a secondary analysis of data comparing prior authorization (PA) policies across 5 major Medicare Advantage insurers to estimate the counterfactual proportion of 2021 Medicare Part B fee‐for‐service s...