Gate Way Group Partner David Jackson Testifies on Health Insurance Legislation

Posted by Dave Berry

Rep. Caleb Jones, R-California, has proposed two bills that seek to change how physicians receive authorization to perform certain radiology procedures, as well as to change the timeline to get authorization from insurance carriers.

The first bill allows physicians to use a computerized clinical decision support system as an alternative to authorization from radiology benefit managers for Medicaid patients.

A clinical decision support system can analyze data to help physicians make clinical decisions, such as whether someone needs a certain procedure.

Radiology benefit managers are individuals who provide prior authorization for imaging services.

“We spend $2.3 million a year for radiology benefit managers,” Jones told the House General Laws Committee on Tuesday. “I believe we can do it better and cheaper.”

He wants to give the state the option to choose what program to use for Medicaid.

“I agree that we need some kind of system in place to check and make sure we’re doing the right thing for citizens of Missouri,” he said. “I want us to have the option to look at this CDS (clinical decision support) system.

“But, this doesn’t require us to do one or the other.”

Elisabeth Quam, executive director of the CDI Quality Institute based in Minneapolis, said radiology benefit managers often act as gatekeepers and make it less likely for physicians to order unnecessary procedures.


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