Is Prior Authorization of Medical Imaging a Good Way to Save Money?


Can prior authorization of medical imaging save money?$319 billion. That’s how much could be saved on healthcare costs if the government acted on Blue Cross and Blue Shield Association’s (BCBSA) recent recommendations.

The problem: medical imaging would get squeezed.

BCBSA’s recommendations follow a by-now familiar pattern: 1) Replace fee-for-service reimbursement with outcome-based reimbursement, 2) Invest in primary care, and 3) Invest in preventative care.

The details, however, bring out the trouble for medical imaging. The recommendations use a partnership between Wellmark Blue Cross Blue Shield and a radiology benefit management company as a model. The partnership relied on prior authorization from the benefit management to reduce the use of medical imaging.

The Medical Imaging Technology Alliance (MITA) and Access to Medical Imaging Coalition (AMIC) have been critical, pointing out the following:

  • There is no peer-reviewed study that shows that prior authorization requirements save money for Medicare.
  • According to the AMA, 63 percent of 2400 physicians surveyed said that prior authorization delays necessary medical treatment.
  • HHS has noted that prior authorization is at odds with “the public nature of the Medicare program” because of its lack of transparency and would be burdensome because of the Medicare appeals process.
  • The State of Delaware shut down Blue Cross Blue Shield’s Delaware prior authorization program after scrutinizing the quality of care received by cardiac nuclear imaging patients.

In the end, BCBSA’s recommendations are just that – recommendations. It is unlikely that Medicare will implement them any time soon. Still, there is little doubt that medical imaging will continue to be a target for cost-cutters in the government and in the healthcare industry in general. What will this mean for medical imaging professionals? Stay tuned. Better yet, subscribe to this blog and keep up to date with  the latest in medical imaging.

Information from a Cardiovascular Business article was used in this post.

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