By Teri Gatchel-Schmidt – In the pursuit of delivering high-quality patient care, the complexities of healthcare management continually present challenges and regulation changes. Example, the Prior Authorization process, overloading medical staffs with administrative and resource demands.
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By Matthew D. Bayley MD – Each year the Medical Group Management Association surveys hundreds of group practices to assess how industry regulations are impacting them. Just as in previous years, the most recent survey shows things are getting worse, not better.
By Chris Emper – In the final two months of 2022, CMS released over 5,000 pages of new regulations and the U.S. Congress passed into law a 4,000-plus page omnibus spending bill that had over 1,000 pages of healthcare provisions.
Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P: Fact Sheet. CMS is continuing to advance our interoperability goals and tackle process challenges related to prior authorization to increase efficiencies in health care.
By Matthew Hawley & Jonathan Starr PharmD – A patient receives automatic refills from a specialty pharmacy for a drug he no longer uses and ends up stockpiling $1 million worth of medication. A pharmacy miscalculates the number of units of a specialty drug prescribed for a patient, resulting in a claim that is $16,000 higher than necessary, yet the claim is paid for by insurance.
AMA survey shows, health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms despite mounting evidence that insurer-imposed authorizations for drugs and medical services can be a hazardous and burdensome administrative obstacle to patients.
By Alex Baker & Michael Wittie – In January 2022, ONC issued a Request for Information that sought public input on the ONC Health IT Certification Program and how it could incorporate standards, implementation specifications, and certification criteria related to electronic prior authorization.
By Scott Overholt – Payer-required administrative tasks are a burden most providers know all too well. They are a daily source of frustration, diverting time from mission-critical work and often delaying patient care. Legislation impacting audit and authorization processes is in constant flux, only increasing confusion about payer requirements and regulations.
By Richard Cohan – Since the 1960s, medical prior authorizations have established a system of checks and balances that help control the costs of medication, services, and procedures. While much has changed since those days, many challenges—such as cumbersome manual processes for payers and providers and delays in care for patients—have remained the same.