decisionhealth Newsletters, Part B News - 2020 Issue 3 (March)
Prior auth projects proliferate — but provider relief from their hassle not coming soon
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Article Overview
This article covers current efforts to reduce the administrative burden of prior authorization in health care, including CMS initiatives, private-sector technology projects, and state and federal policy developments. It is relevant to providers, revenue cycle teams, health IT stakeholders, and payer-policy observers who want to understand why prior authorization remains burdensome and what kinds of technical or regulatory changes are being discussed.
Why This Topic Matters
Prior authorization affects patient access, practice workflow, and payment operations, so changes in standards, automation, or enforcement can have broad operational impact for medical groups and payers.
Article Sections
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Tech interventions slowly build
Discusses ongoing automation and interoperability efforts aimed at making prior authorization and related documentation workflows more efficient. Covers CMS, industry collaboration, and private-sector technology approaches.
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Feds may help, or not
Reviews the policy and regulatory environment surrounding prior authorization, including payer incentives, state legislative activity, and expectations for federal action.
What You Will Learn
- How prior authorization reform is being approached through technology and policy
- Which organizations are involved in automation and interoperability efforts
- What role state and federal governments may play in changing prior authorization processes
- Why stakeholders believe progress may be slow despite active projects
Who Should Read This
- Physician practices
- Revenue cycle managers
- Health information technology professionals
- Payer policy analysts
- Medical practice administrators
Code Ranges Discussed
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