Fewer Denials? CMS Aims To Reform Prior Authorization For Medicaid
The goals are to ensure that care is not delayed, integrity is maintained and administrative costs aren't increasing, CMS Administrator Seema Verma said in a statement.
The Trump administration on Thursday proposed changes that aim to improve patient and provider access to medical records and reform prior authorization. The proposed rule would require payersincluding Medicaid, Children's Health Insurance Program and exchange plansto build application program interfaces to support data exchange and prior authorization. According to CMS, the changes would allow providers to know in advance what documentation each payer would require, streamline documentation processes and make it easier for providers to send and receive prior authorization information requests and responses electronically. (Brady, 12/10)
The proposed rule, released Thursday by the Centers for Medicare & Medicaid Services (CMS), requires payers in certain government programs to build application programming interfaces (APIs) for data exchange and prior authorization. The rule tackles a common complaint from providers that prior authorization has increased in use among plans and takes up too much time away from patients. Prior authorization is a necessary and important tools for payers to ensure program integrity, but there is a better way to make the process work more efficiently to ensure that care is not delayed and we are not increasing administrative costs for the whole system, said CMS Administrator Seema Verma in a statement. (King, 12/11)
Also
The Centers for Medicare and Medicaid Services has posted updates to frequently asked questions and an infographic about coverage and payment for monoclonal antibodies to treat COVID-19.The FAQs include general payment and billing guidance on lab testing, hospital services and inpatient prospective payment system payments, including questions on different setting types. (Morse, 12/10)
In news about "Medicare For All"
Xavier Becerra has long supported moving the United States to a Medicare for all system. As President-elect Joe Bidens pick to run Health and Human Services, he may have opportunities to speed up such a transition. The Health and Human Services secretary oversees an array of waivers that states can use to cover new groups or provide different types of health plans. Because these waivers do not require congressional approval, they could become a crucial policymaking tool for the Biden administration if Republicans retain control of the Senate. (Kliff, 12/10)
President-elect Joe Bidens choice for secretary of health and human services, Xavier Becerra, has previously supported transitioning to a single-payer system and if approved for the new Cabinet role he would be able to advance that policy if he wanted. Becerra said in a 2017 interview with Fox News that he absolutely supports Medicare-for-Alland had done so for all 24 years. (De Lea, 10/8)
