The prior auth process has always been a major cause of stress and frequent burnout for many providers for ages. Though there has been a continuous effort to reduce the burden caused but not much has transpired till date.
In fact, recently to manage, improve and expedite the prior authorization process for patient treatment – the U.S. Centers for Medicare & Medicaid Services (CMS) are pioneering significant changes hoping for progress. though the proposed reforms were discussed during the quarterly stakeholder conference call on January 24, 2023, providing a recap of 2022 led by CMS Administrator Chiquita Brooks-LaSure; these developments are indicative of CMS’s commitment to enhancing the healthcare system by making it more accessible and efficient – with the intention to ensure that people have access to the care they need when they need it.
In fact, below are the reforms by CMS-
- Today one of the leading cause of frequent burnout among payers are the difficulties associated with prior authorization often leading to patients either paying out of pocket or abandoning treatment due to delays. This also adds unnecessary workload for payers who lack the upfront information needed to make decisions. Hence, CMS aims to establish a prior authorization process that is efficient, transparent, and standardized, ensuring timely access to care and treatment.
- CMS further proposed a rule change that mandates payers to provide reasons for denials and ensure quicker turnarounds, within 48 hours for urgent requests. with the aim to boost patient and provider access to health information and streamline prior authorization processes across different sources of healthcare coverage.
- Thirdly, the rule proposes requirements for payers to approve the electronic exchange of health data, electronic prior authorization, and establish timeframes for responses to prior authorization requests. It also mandates the publication of metrics concerning approval and appeals rates.
- Fourthly, the standardization of “health care attachments,” i.e., medical charts, x-rays, and provider notes used for physician referrals. The proposed rule is to adopt standards for these healthcare attachment transactions, supporting both healthcare claims transactions and prior authorization transactions to make the task easy and efficient for all. As this would not only enable providers to send more complete clinical information to payers but facilitate a more efficient prior authorization process.
In fact, taken together, these proposed rules aim to provide patients, providers, and payers with the necessary information to navigate the prior authorization process swiftly. This will not only expedite decisions and help patients receive the care they need more quickly but also offer patients more visibility into how plans handle prior authorizations.
Aiming to standardize the technical approach across Medicare, Medicaid, and insurance programs available through the Affordable Care Act Marketplace programs and thereby simplifying the prior authorization process for providers you still need an experienced authorization specialist to manage it all.
Sunknowledge – the prior auth specialist you need:
helping you with complete prior auth services starting from initiation, approval and follow up and promising step forward in the quest for a more efficient and patient-centric healthcare system; Sunknowledge for the last 15+ years is known for delivering state of art solutions.
Tackling all your preauthorization challenges and offering dedicated resources managing your authorization, partnering with Sunknowledge guarantees;
- cost reduction
- 100% authorization submission same day
- 97% first pass collection
- no write-offs without consent
- no-cost dedicated resources offering seamless authorization transactions at a cost effective rate and more
So if you looking to improve your authorization or get rid of the authorization burden, Sunkowledge Services Inc is here to help.
For more information, talk to the expert to now and know how Sunknowledge can make a difference.
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