CMS announces new prior authorization program pilot

The Centers for Medicare & Medicaid Services June 27 announced the rollout of a 6-year technology-enabled prior authorization program pilot. Through the Wasteful and Inappropriate Service Reduction Model pilot, CMS will partner with third-party entities to implement a technology-based prior authorization program for a specified list of services delivered to patients with traditional fee-for-service Medicare. Under the regionally based model, participating providers will have the choice of submitting prior authorization requests for selected items and services or subjecting their post-service claim to pre-payment medical review.