The American Hospital Association is urging CMS to finalize its proposed rule for reforming the prior authorization process but has suggested some changes, including shortening the amount of time payers have to make a determination.
Under CMS' proposed rule, payers have a seven-day time frame to make determinations for standard prior authorizations and 72 hours for expedited authorizations. The AHA argued in a March 13 letter to CMS that these time frames are "unreasonably lenient." It is instead suggesting a 72-hour time frame for standard authorization and 24 hours for urgent authorizations.
The AHA is not the only organization asking CMS to shorten the time frame. The Medical Group Management Association is suggesting time frames to be shortened to 48 hours for standard prior authorizations and 24 hours for expedited prior authorizations.
The AHA said CMS' proposed rule is a welcome step toward helping patients get timely access to care and clinicians focus their limited time on patient care rather than paperwork, according to the letter. To truly realize these benefits, CMS must "ensure a baseline level of enforcement and oversight."
"In addition, while hospitals and health systems appreciate CMS' effort to improve the electronic exchange of care data to reduce provider burden and streamline prior authorization processes, we urge CMS to ensure that any electronic standards are adequately tested and vetted prior to mandated adoption," the AHA said in the letter.
Read the full letter here.