decisionhealth Newsletters, Part B News - 2022 Issue 3 (March)
Prior auth still plagues practices, but CMS, lawmakers remain idled
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Article Overview
This article covers the continuing burden of prior authorization on medical groups and physicians, along with the policy and technology responses being discussed at state and federal levels. It is relevant to practice managers, revenue cycle leaders, physicians, and health policy stakeholders who track payer process changes, CMS initiatives, and legislation aimed at reducing administrative work. The discussion includes industry survey findings, state “gold card” approaches, CMS requests for information, proposed federal rulemaking, and broader efforts to streamline authorization workflows.
Why This Topic Matters
Prior authorization affects care access, staffing, and administrative workload across many practices. Understanding the current reform landscape helps organizations follow policy changes that may affect payer interactions and workflow planning.
Article Sections
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Practice management
Introduces the ongoing administrative burden of prior authorization and summarizes survey-based concerns reported by medical groups and physicians.
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Friction in the system
Discusses how stakeholders view prior authorization as part of broader payer-related administrative friction and contrasts federal versus state approaches to reform.
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States make a push to glisten gold
Reviews state-level efforts and examples involving streamlined prior authorization concepts, compliance actions, and payer process changes.
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CMS takes aim, but no action
Summarizes CMS requests, proposed rulemaking, and related federal comments focused on electronic prior authorization and documentation lookup concepts.
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How MA focus may improve PA problem
Explores views on Medicare Advantage-related process standardization, electronic transactions, and other technical or regulatory approaches to reduce burden.
What You Will Learn
- How prior authorization continues to affect medical groups and physician practices
- Which state and federal reform efforts are being discussed
- What kinds of process and technology changes stakeholders want from payers and regulators
- How CMS, Medicare Advantage, and other programs are part of the current policy debate
Who Should Read This
- Medical practice administrators
- Revenue cycle professionals
- Physicians
- Health care policy analysts
- Payer relations staff
- Compliance and operations teams
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