Evaluation of Prior Authorization in Medicare Nonemergent Ambulance Transport

Abstract

Key Points Question What is the association between a prior authorization requirement for nonemergency ambulance transportation and Medicare costs, patient access to care, and health outcomes for Medicare beneficiaries subject to the Repetitive, Scheduled, Non-Emergent Ambulance Transport Prior Authorization pilot program? Findings In this difference-in-differences analysis of 1.7 million Medicare beneficiaries, expenditures for repetitive, scheduled, nonemergency ambulance transport were significantly reduced by 77% and total Medicare expenditures were significantly reduced by 2.4% per beneficiary-year. No clear evidence was found for material changes to patient outcomes. Meaning When prior authorization is targeted to services with high improper usage rates, this study suggests that it may be associated with reduced costs without materially changed access to care or patient health.

Generative AI for analysis and identification of Medicare improper payments by provider type and HCPC code

“… 3 Some Medicare-reimbursed services are overused or improperly used, resulting in payments for unnecessary services. 4 In other words, reducing Medicare improper payments can lead to a reduction in Medicare expenditures. The aim of this paper is to identify the causes of improper payments by provider type and HCPC code, respectively.…”