On MA prior auth, Congress proposes relief — but CMS is ahead of the game
Published:
August 10, 2023
A couple of new bills — or rather, retreads of old bills — demonstrate increased congressional interest in reforming prior authorization (PA) under Medicare Advantage (MA). While the success of these bills is not assured, a recent proposed rule shows CMS is willing to move on this issue itself, with Congress serving more as a cheerleader than as a legal authority.
Cohere Health’s Alina M. Czekai, Vice President of Value-Based Care Strategy & former Senior Advisor to CMS Administrator Seema Verma, who worked on the original rule, sat down with Roy Edroso, Editor, Part B News, to discuss how the legislation would improve transparency within the prior authorization process, reduce physician burden, and result in faster access to patient care.
Written by
Cohere
Health
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction. Cohere Health is recognized on TIME’s World’s Top HealthTech Companies 2025 list, on the 2025 Inc. 5000 list, and by numerous industry analysts.
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