[{"innerBlocks":[],"name":"core\/freeform","postId":262,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"The Medical Group Management Association wants to see to Medicare limits for any application of prior authorization by \u201cgold carding\u201d physicians and automating any remaining requirements.MGMA submitted a response on Wednesday to a request for information from the Centers for Medicare and Medicaid Services on the use of prior authorization in the Medicare program\u2014a process by which health insurers require doctors to first obtain approval before conducting a procedure or prescribing a medication.

\u201cDecreasing access to care for Medicare beneficiaries and increasing provider burden through the imposition of challenging prior authorization requirements is not the appropriate pathway to promoting integrity in the Medicare program,\u201d wrote Anders Gilberg, senior vice president of government affairs at MGMA, to CMS Adminstrator Seema Verma.\u201cRather than increasing the use of authorizations, CMS should identify opportunities within the Medicare program to promote program integrity and in the broader healthcare environment to reduce the overall volume of prior authorizations and automate the remainder,\u201d he continued.While Gilberg states in his letter to Verma that MGMA opposes prior authorization requirements on physicians treating Medicare beneficiaries, if they are to be imposed for certain covered services, the group wants CMS to develop a streamlined process that does not distract from patient care and does not add to practice burden.\u201cThere are a number of opportunities to achieve these goals, including use of real-time or near real-time tools and processes and full transparency regarding what covered services, tests, DME or medications require a prior authorization and what documentation is needed to support a prior authorization or a post-payment Medicare audit,\u201d according to MGMA.The group describes the current prior authorization process as \u201ccumbersome, heavily reliant on manual processes\u201d and one that \u201cleads directly to delays and denials of care.\u201d According to MGMA, the prior authorization process must be either eliminated or streamlined, including better integrating it with electronic health record systems.\u201cWhen prior authorization is required, CMS should make every effort to automate the process,\u201d states MGMA\u2019s letter. \u201cFor example, in the area of medications, Medicare should provide, and vendors display, accurate, patient-specific and up-to-date formularies that include any prior authorization requirements and step therapy requirements in EHR systems for purposes that include electronic prescribing and electronic prior authorization.\u201dIn addition, MGMA makes the case that other opportunities exist to streamline prior authorization by leveraging existing electronic transaction standards and mandating a new standard for clinical documentation transmission. \u201cIncreased use of the prior authorization electronic transaction would result in significant savings to both plans and providers,\u201d states the letter. \u201cThe current practice for medical groups is to fax, mail or upload to proprietary websites the clinical data necessary to conduct prior authorizations. By leveraging EHR technology, the electronic attachment standard (X12 275) would automate the collection and transmission of clinical data in support of a prior authorization.\u201d","saveContent":"The Medical Group Management Association wants to see to Medicare limits for any application of prior authorization by \u201cgold carding\u201d physicians and automating any remaining requirements.MGMA submitted a response on Wednesday to a request for information from the Centers for Medicare and Medicaid Services on the use of prior authorization in the Medicare program\u2014a process by which health insurers require doctors to first obtain approval before conducting a procedure or prescribing a medication.

\u201cDecreasing access to care for Medicare beneficiaries and increasing provider burden through the imposition of challenging prior authorization requirements is not the appropriate pathway to promoting integrity in the Medicare program,\u201d wrote Anders Gilberg, senior vice president of government affairs at MGMA, to CMS Adminstrator Seema Verma.\u201cRather than increasing the use of authorizations, CMS should identify opportunities within the Medicare program to promote program integrity and in the broader healthcare environment to reduce the overall volume of prior authorizations and automate the remainder,\u201d he continued.While Gilberg states in his letter to Verma that MGMA opposes prior authorization requirements on physicians treating Medicare beneficiaries, if they are to be imposed for certain covered services, the group wants CMS to develop a streamlined process that does not distract from patient care and does not add to practice burden.\u201cThere are a number of opportunities to achieve these goals, including use of real-time or near real-time tools and processes and full transparency regarding what covered services, tests, DME or medications require a prior authorization and what documentation is needed to support a prior authorization or a post-payment Medicare audit,\u201d according to MGMA.The group describes the current prior authorization process as \u201ccumbersome, heavily reliant on manual processes\u201d and one that \u201cleads directly to delays and denials of care.\u201d According to MGMA, the prior authorization process must be either eliminated or streamlined, including better integrating it with electronic health record systems.\u201cWhen prior authorization is required, CMS should make every effort to automate the process,\u201d states MGMA\u2019s letter. \u201cFor example, in the area of medications, Medicare should provide, and vendors display, accurate, patient-specific and up-to-date formularies that include any prior authorization requirements and step therapy requirements in EHR systems for purposes that include electronic prescribing and electronic prior authorization.\u201dIn addition, MGMA makes the case that other opportunities exist to streamline prior authorization by leveraging existing electronic transaction standards and mandating a new standard for clinical documentation transmission. \u201cIncreased use of the prior authorization electronic transaction would result in significant savings to both plans and providers,\u201d states the letter. \u201cThe current practice for medical groups is to fax, mail or upload to proprietary websites the clinical data necessary to conduct prior authorizations. By leveraging EHR technology, the electronic attachment standard (X12 275) would automate the collection and transmission of clinical data in support of a prior authorization.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

MGMA calls on CMS to limit prior authorization requirements

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