The American College of Radiology® (ACR®) submitted comments to the Centers for Medicare and Medicaid Services (CMS) Jan. 24, that support the agency’s ongoing efforts to streamline and improve utilization management policies. CMS proposals would affect prior authorization in the 2026 Medicare Advantage program. The agency said proposed changes would ensure services are provided equitably irrespective of the delivery method (e.g., using artificial intelligence to make determinations). One proposal would require prior authorization metrics to be reported by each item or service rather than aggregated data, building on policies CMS included in prior rules to increase transparency to providers and beneficiaries.
ACR recommended CMS consider the use of a qualified Clinical Decision Support Mechanism (CDSM) to adhere to the proposals. The use of physician-developed and evidence-based Appropriate Use Criteria (AUC) can ensure that prior authorization processes can help reduce administrative burden, as well as lead to potential savings of $700 million annually to the Medicare program by reducing unnecessary imaging orders.
CMS released a fact sheet with more information about its proposals.
If you have questions, contact Kimberly Greck, ACR Senior Economic Policy Analyst.
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