8 prior authorizations updates in 2022

From a proposed CMS rule to streamline the process to states passing reforms, here are eight updates on prior authorization that Becker's has reported in 2022: 

1. CMS issued a proposed rule Dec. 6 that it says will streamline the prior authorization process and estimated the efficiencies introduced in the proposal would save hospitals and physician practices more than $15 billion over a 10-year period. 

2. Pennsylvania Gov. Tom Wolf signed a law Dec. 3 that, among other things, requires insurers to provide timely approval for nonurgent and emergency healthcare services to physicians before services and treatment plans are rendered. It creates a timely process for appeals determinations, and if an insurer questions the necessity of a service, the bill calls for a peer review by a physician from the specialty in question.

3. Blue Cross Blue Shield of Massachusetts, Florida Blue and other payers have worked to implement different strategies to reform their prior authorization systems this year. 

4. The effects of Texas' gold-card law kicked in Oct. 1. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services.

5. The U.S. House of Representatives unanimously passed a bill Sept. 14 to reform the Medicare Advantage prior authorization process. The bill remains under consideration in the Senate, as of Dec. 22. 

6. A report from the HHS Office of the Inspector General released April 27 found Medicare Advantage Organizations sometimes delayed or denied enrollees' access to services even though the request met Medicare coverage rules. The investigation was conducted by selecting a stratified random sample of 250 denials of prior authorization requests and 250 payment denials issued by 15 of the largest Medicare Advantage Organizations from June 1-7, 2019. 

7. Four revenue cycle leaders shared with Becker's how they would change the prior authorization process.  

8. Michigan Gov. Gretchen Whitmer April 7 signed a bill that shortens the time payers have to consider prior authorization requests before they are considered granted and requires payers to provide more information to the public and providers regarding the prior authorization process.

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