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HealthMedical Xpress

Medicare's prior-authorization pilot test led to an immediate drop in use of services

For many years, traditional Medicare has operated almost entirely without prior authorization, a requirement that clinicians obtain approval before certain services will be covered. The practice is controversial because it adds paperwork, outside review and other barriers that can delay or deny coverage for recommended treatment. While prior authorization is widely used by commercial insurers and Medicare Advantage, traditional Medicare has historically almost never required it.

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