CMS Seeks Input From Physicians and Practices on Impact of Prior Authorization

ISASS asks members to submit letter to CMS
August 23, 2019
CMS Issues Final Rule on Inpatient Rehabilitation Facilities
August 28, 2019

Centers for Medicare and Medicaid Services Administrator Seema Verma has tasked her Patients Over Paperwork team with exploring what CMS can do to improve Prior Authorization (PA) burdens as part of the eighth topic addressed under the initiative. They are conducting many listening sessions with various stakeholders over the next few weeks, including a wide range of providers and health plans, to gather information on burdens and suggestions on what CMS can do on this issue. They are also visiting practices to observe the PA process in action.

In this effort, CMS is looking for data on PA. They are particularly interested in the following data points in advance of taking meaningful action:

  • Practice costs to complete PA tasks, particularly any data on the number of full-time staff per physician needed to manage the PA workload
  • Data about patient harms and negative impact on care quality related to PA; CMS has a specific interest in treatment abandonment
  • Information illustrating payer contracting tactics to coerce unrestricted access to physicians’ electronic health records

If your practice is contacted by CMS, please provide any information and data on PA burdens.

ISASS has been a signatory to an AMA taskforce report on PA impacts and continues to work closely with the AMA and other medical specialties.

Click here to read the Prior Authorization and Utilization Management Reform Principle Statement