CMS issued a new proposed rule to streamline prior authorization for medical items and services, and industry leaders have good things to say.
The rule would require certain payers to implement electronic prior authorization, shorten time frames for certain payers, and establish processes that make prior authorization more transparent and efficient.
The new rule would also require payers to provide a specific reason when denying requests. Additionally, it would require decisions to be sent within 72 hours.
The proposed rules would apply to Medicare Advantage organizations, state Medicaid and Children's Health Insurance Program agencies, among others.
"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 of government affairs at the Medical Group Management Association, told Becker's. "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."