Back in February 2018, the American Medical Association (AMA) released a Consensus Statement on Improving the Prior Authorization Process in collaboration with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, the Blue Cross Blue Shield Association, and the Medical Group Management Association. The group collectively acknowledged, “The prior authorization process can be burdensome for all involved—health care providers, health plans, and patients.” Yet five years later, prior authorization volume has exploded. Prior authorization automation can relieve the pressures providers and payers face, while accelerating the process so patients get the care they need, when they need it. … Read entire article here
May 2, 2023
The Future of Prior Authorization in Medicare Advantage Plans: New (and Pending) CMS Rules Promise Progress on Prior Authorization Automation
by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization
A decade ago, just over a quarter of eligible Medicare beneficiaries enrolled in Medicare Advantage (MA) plans. As of this year, reports the Centers for Medicare & Medicaid Services (CMS), more than half of enrollees chose MA plans over traditional Medicare. Despite the obvious popularity of MA plans, a problem lurks: overuse of prior authorizations. Because of this, the CMS has begun introducing rules to address the issue, including standards to enable prior authorization automation. MA delays and denials fail to follow Medicare standards A year ago, the Department of Health and Human Services (HHS) Office of Inspector General (OIG)… Read entire article here
In early April, HealthDay reporter Dennis Thompson wrote, “Much has been made of burnout among doctors and nurses, but a new survey has found high rates of work fatigue in nearly every type of job associated with healthcare.” His comments refer to a recently published report in the Journal of General Internal Medicine. The report found similar burnout rates among all healthcare workers: 47% of physicians 56% of nurses 54% of clinical staff 46% of non-clinical staff One of the biggest reasons? Prior authorization. Fortunately, that’s a solvable problem with the help of prior authorization software. First, let’s look at… Read entire article here
No industry escapes administrative spending, but the healthcare industry encounters more than its fair share. Writing in Forbes, Bipartisan Policy Center Senior Fellow and Former Senate Majority Leader Bill Frist notes, “Estimates attribute 15 – 30 percent of total national health spending to administration, with at least half of that spending demonstrated to be ineffective or wasteful. That means as much as $300 - $600 billion is wasted each year.” Tackling inefficiencies in your processes—like over-processing prior authorization submissions—can certainly cut down on waste. That’s where prior authorization software can help. But first, let’s look at why it happens. A… Read entire article here
