Changes to Medicare Advantage Star Ratings and Prior Authorization Process
The Center for Medicare and Medicaid Services (CMS) recently announced changes to the Medicare Advantage program. These changes include updates to the prior authorization process and the Medicare Advantage star ratings system.
What is Prior Authorization?
Prior authorization is when a healthcare provider must get approval before providing certain medical services. Under the new changes, Medicare Advantage plans will get more credit for completing prior authorizations in a timely manner. This means that if your healthcare provider asks for approval of a service you need, your Medicare Advantage plan will have two calendar days to respond instead of three. The new system will give more weight to services that need prior authorization more frequently, such as physical therapy, occupational therapy, and speech therapy.
What are Medicare Advantage Star Ratings?
Medicare Advantage star ratings are a way to measure the quality of care that Medicare Advantage plans provide to their beneficiaries. The CMS recently made changes to the Medicare Advantage star ratings system. The new system will give more weight to patient experience and outcome measures and less weight to process measures. This means that Medicare Advantage plans will be incentivized to focus on improving the health outcomes of their beneficiaries.
What does this mean for you?
The changes to the prior authorization process and the Medicare Advantage star ratings system are designed to improve the Medicare program for beneficiaries like you. The prior authorization process will become more efficient and transparent, making it easier for you to receive the medical services you need. The Medicare Advantage star ratings system will encourage Medicare Advantage plans to focus on providing better quality care to their beneficiaries.
