Healthcare groups are largely excited by a new proposed rule from the Centers for Medicare and Medicaid Services (CMS) that aims to streamline prior authorization and reduce burden on healthcare providers.
The proposed rule includes several changes that would enhance the prior authorization system by speeding up approvals, requiring new modern standards for payers to communicate about patients across systems and more. According to CMS, the changes will save physicians practices and hospitals $15 billion over 10 years.
Healthcare industry groups have advocated for reducing prior authorization on providers for years, arguing that the requirements are extremely burdensome and costly on providers. Plus, prior authorization can lead to delayed care while providers await approval from payors. After CMS published its proposed rule, several industry groups spoke up about their support for the changes. See their comments below:
- “MGMA is encouraged to see that CMS heeded our call to include Medicare Advantage plans in the scope of this proposed rule,” Anders Gilberg, senior vice president, government affairs at MGMA, said in a statement. “An alarming number of medical groups report completing prior authorization requests via paper forms, over the phone, or through varying proprietary online payer portals. The onerous methods of completing these requests, coupled with the increasing volume is unsustainable. An electronic prior authorization program, if implemented appropriately, has the potential to alleviate administrative burden and allow practices to reinvest resources in patient care. This is a positive step forward for both medical groups and the patients they treat. We look forward to working with CMS to refine and finalize this rule.”
- “Every American should have the personalized health care information they need, so they can make better, more informed decisions before they seek and receive care. We applaud CMS for putting patients first with a proposed rule that allows them to easily share their data with entities of their choosing,” said Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP). “This proposed rule would require clinicians and hospitals to adopt electronic prior authorization to meet certain quality measures, ensuring that we are all incentivized to work together for a better patient and clinician experience that improves satisfaction, efficiency, and affordability for everyone.”
- “The AHA commends CMS for taking important steps to remove inappropriate barriers to patient care by streamlining the prior authorization process for some health insurance plans,” said Ashley Thompson, senior vice president, public policy analysis and development of the American Hospital Association (AHA). “Hospitals and health systems especially appreciate that CMS included Medicare Advantage plans in these requirements, as the AHA has urged. Prior authorization is often used in a manner that results in dangerous delays in care for patients, burdens health care providers and adds unnecessary costs to the health care system. The AHA looks forward to carefully reviewing the proposed rule, and we continue to urge the Senate to pass the Improving Seniors’ Timely Access to Care Act to codify these protections in law."
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."