The APMA Board of Trustees has approved two new position statements addressing persistent challenges podiatric physicians face in the Medicare Advantage (MA) program and with prior authorization (PA) processes.
Together, these statements reinforce APMA’s commitment to protecting patient access to medically necessary foot and ankle care while reducing administrative burdens that delay treatment and undermine physician decision-making.
Medicare Advantage: Transparency, Reducing Burden, and Reforming Prior Authorization
APMA’s Medicare Advantage position focuses on three priority areas: transparency in coverage and reimbursement, reducing excessive chart reviews, and reforming prior authorization.
APMA continues to hear from members that MA plans deny or underpay services that are clearly covered under traditional Medicare, including at-risk foot care. The statement calls for MA plans to align coverage and reimbursement policies with Medicare fee-for-service standards, adhere to National Correct Coding Initiative (NCCI) edits and Centers for Medicare and Medicaid Services (CMS) guidance, and reimburse providers at least at Medicare rates.
The statement also raises concerns about the growing volume of chart review requests, particularly for small and solo practices, and urges greater CMS oversight to prevent misuse of chart reviews that divert time and resources away from patient care.
Prior Authorization: Streamlining Processes and Reducing Delays
APMA’s prior authorization position outlines a comprehensive framework to standardize and streamline PA processes, reduce administrative burdens for podiatric physicians, strengthen transparency around artificial intelligence (AI) use, and reform peer to peer reviews. Key recommendations include adopting electronic prior authorization systems, enforcing timely decision-making, and increasing transparency around coverage requirements and denial patterns.
The statement strongly supports gold carding programs that exempt consistently compliant podiatric physicians from unnecessary PA requirements, helping ensure timely care for patients with urgent conditions such as diabetic foot ulcers and fractures.
APMA also calls for limits on the use of artificial intelligence in PA decision-making, clear disclosure when AI is used, protections against retroactive denials after coverage confirmation, and peer-to-peer reviews conducted by podiatric physicians for podiatric claims.
With these Board-approved positions, APMA is reinforcing its advocacy with policymakers and payers to promote reforms that preserve patient access, recognize the expertise of podiatric physicians, and enhance care quality.
Please visit APMA’s position statements page to learn more about the association’s official views on key policy issues.