In July, Reps. Michael Burgess, MD, and Vicente Gonzalez, both of Texas, introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans.
Dr. Burgess, a retired OB-GYN, recently spoke to the American Hospital Association about why he is pursuing the bill, which would exempt physicians from Medicare Advantage plan prior authorization requirements if 90% of the physician's prior authorization requests were approved in the preceding 12 months.
"Here's the proposition, and we've all heard this I don't know how many times: 10% of the people are causing 90% of the problems," Dr. Burgess told the AMA, according to a Dec. 28 post on the organization's website. "This kind of turns that around and says, 'Hey, if you're one of the 90% that is doing everything right and by the book and your procedures are always approved—or 90% of the time approved—you don't need to keep going through this process. We're going to trust you that the next case will be just as indicated as the last case.'"
Texas implemented a gold-card rule that took effect in October 2022.
Dr. Burgess also said he is looking at other ways to reform and streamline the prior authorization process, according to the article. That includes making the collection of data automatic.
"Not something that someone has to actually collect and submit, but make it automatic through an automated claims process," he said.