In December, CMS submitted a 134-page proposal designed to improve prior authorizations for Medicare and Medicaid patients through automating the process and improving workflows.
The proposal requires certain payers to address the administrative hassles of prior authorization by requiring the implementation of an automated process, meeting shorter time frames for decision-making and improving transparency.
Some surgeons, including Lali Sekhon, MD, PhD, a spine and neurosurgeon at Reno (Nev.) Orthopedic Center, are still skeptical that CMS' proposals will become reality and are waiting to see actual changes and results.
Dr. Lali Sekhon: The proof of the pudding will be the eating. Just like hospitals and transparency of billing, payers will do all they can to avoid this, confuse this and mitigate delays/denials/deferrals to make the end-of-quarter balance sheets look better.