If you were to guess how many physicians reported that prior authorization led to care delays for patients, what would you guess? A recent American Medical Association survey found that 93% of physicians reported that prior authorization led to care delays.
Regulatory reform is transforming the prior authorization landscape. That’s why the “Improving Seniors’ Timely Access to Care Act” has bicameral, bipartisan support. The bill recently passed the House, and the Senate is expected to follow suit before the end of the year. The act aims to align the commercial Medicare Advantage (MA) plans more closely with traditional Medicare to promote health equity for all Medicare beneficiaries.
What does this mean for your plan? Here are three things you need to know. The upcoming legislation:
- Requires MA plans to implement electronic prior authorization (ePA) programs that adhere to newly developed federal standards, establishing real-time decision-making processes for items and services identified as “routinely approved.”
- Mandates that MA plans issue accelerated prior authorization decisions for all other services covered by MA plans (i.e., under Medicare Part C).
- Enhances transparency by requiring MA plans to report to CMS their usage of prior authorization, including approval and denial rates.
These three steps are a great place to start. Download this regulatory white paper to learn how to unpack the changes and prepare your plan.
Featured Content
News You Can Use
Practices Most Frustrated With Prior Auths, Then No Surprises Act (Revcycle Intelligence)
Nearly 82% of medical practices rated prior authorizations as very or extremely burdensome.
💰 Wasteful Admin Spending Costs U.S. Healthcare Up to $570 Billion a Year (Fierce Healthcare)
Administrative spending makes up 15% to 30% of all U.S. medical spending.
Pennsylvania Prior Authorization Reform Bill Signed Into Law (Becker’s Healthcare)
New state law requires insurers to provide timely approval for nonurgent and emergency healthcare services.
Cohere Minute
🪡 New Legislation Moves the Needle on Prior Authorization Reform (First Report Managed Care)
Plans may soon be required to offer greater transparency regarding their policies, approval rates, and rationale for denied requests.
⚙️ Using Technology to Improve the Prior Authorization Process (Healthcare IT News)
How can AI and machine learning applied to the prior authorization process reduce payer, provider, and patient friction?
📈 Fixing Prior Authorization: How to Improve Outcomes Using Episodic Care Paths (Managed Healthcare Executive)
Why must UM programs evolve to address the entire patient care journey across multiple episodes of care? To improve patient outcomes!
🥼 ‘Care Delayed Is Care Denied’: What Prior Authorization Changes Mean For Home Health Providers (Home Health Care News)
The “Improving Seniors’ Timely Access to Care Act” will impact the prior authorization process for health plans, home health providers, and patients.
