New regs could reduce administrative burdens physicians and delays in patient care.
It is time for federal regulators to reform the prior authorization process for health care services, according to the Medical Group Management Association (MGMA).
The U.S. Centers for Medicare & Medicaid Services (CMS) is taking public comments on proposed rules to change the prior authorization process for Medicare Advantage plans starting in January 2026. New rules could lead to an estimated savings of $15 billion for physician practices and hospitals over 10 years, according to CMS.
Apart from possible financial benefits, those changes can’t come soon enough because prior authorizations are causing paperwork headaches for physicians and medical staff, while delaying care for patients. The problem was a burden for medical groups in 2021 and is getting worse, according to MGMA, citing membership poll data from last year.
“Physician groups point to delays in prior authorization decisions, resubmission of prior authorization, inconsistent payer payment policies, issues with peer-to-peer authorizations, unsustainable prior authorization volumes, and prior authorizations for routinely approved items and services as some of the most challenging aspects of prior authorization,” said the Feb. 10 letter from Anders Gilberg, MGMA senior vice president for government affairs, to CMS Administrator Chiquita Brooks-LaSure.
CMS has published at least 25 public comments so far on the proposed rule changes. CMS announced the rule changes in December 2022 and has an information sheet about the proposals. There also is an official Federal Register notice with instructions on how to submit comments.