CMS Cracks Down on Medicare Advantage Plans Hiding Prior Auth Rules Behind 832-Page Code Walls

The Centers for Medicare & Medicaid Services (CMS) is moving to close glaring loopholes in prior authorization transparency following a scathing review by the American Medical Association (AMA). The AMA's investigation found that several Medicare Advantage (MA) plans were exploiting technicalities to bury required billing code disclosures, leaving patients and medical billing professionals completely in the dark.

The AMA's review, which evaluated 15 Medicare Advantage contracts, revealed that while plans appeared to comply with the surface-level requirements of the 2024 CMS Interoperability and Prior Authorization final rule, they were actively obstructing access to the data in practice.

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