April 30, 2020

ACR Asks Private Payers to Suspend Prior Authorization Requirements

As radiology practices begin to reopen to again perform non-emergent diagnostic imaging, members of the American College of Radiology® (ACR®) are concerned about the backlog of non-COVID-19 services that were cancelled or deferred during the public health emergency. The College has, therefore, requested the assistance of commercial payers to ensure patients have timely access to important testing and treatment that was put on hold during the COVID-19 crisis.

In letters to the top five national commercial health insurance companies — United Healthcare, Aetna, Cigna, Anthem and Health Care Service Corporation — the ACR asked that they suspend prior authorization requirements for imaging services during the public health emergency and for the first three months after the end of the public health emergency. A moratorium on prior authorization would significantly help radiology practices and their referring providers best serve their patients and assist in ensuring an efficient recovery from the enormous backlog of imaging exams that have accumulated since the emergency was declared.

Hospitals and physician practices are experiencing significant revenue losses from the cancellation of non-emergent services. In response, they have been forced to lay off or furlough employees in all types of care settings, including staff dedicated to prior authorization processes in referring physician and imaging practices. Without mitigation, prior authorization will become a major barrier for primary care physicians and various specialists as they address the backlog.

The Centers for Medicare and Medicaid Services issued guidance last week encouraging Medicare Advantage plans to exercise their right to waive or relax prior authorization requirements “in order to facilitate access to services with less burden on beneficiaries, plans and providers.” The ACR is urging commercial insurers to do the same.

For questions about the ACR’s request or to obtain a copy of the letter to send to local payers in your state, contact Kathryn Keysor, senior director, economics and health policy.