The American Medical Association is pushing for tighter protections over prior authorization requirements due to continued physician frustration.
Here are four things to know:
1. At a recent meeting, the AMA called for reforms and adopted new policies to reduce financial strain on providers and patients by ensuring preapproved care is paid without retrospective denials, according to a Nov. 12 news release shared with Becker's.
2. Under the new policy, the AMA is directed to back a federal ban on insurers denying payment for precertified, medically necessary care. The AMA will also encourage legal action against insurers who inappropriately recoup or deny payments after services are rendered.
3. "Prior authorization, once granted, should be sufficient to guarantee payment," Marilyn Heine, MD, AMA board member, said in the release. "It is unacceptable that a health plan gives a ‘green light’ to medically necessary care and then retains or creates barriers to payment. It's an affront to physicians, patients and employers; and leads to financial strain for practices and families."
4. The AMA's advocacy and FixPriorAuth campaign have resulted in state and federal policymakers working towards prior authorization reforms in 2024, including CMS introducing regulations to improve efficiency for patients and physicians and reduce prior authorization delays. In 2024, more than 12 states enacted AMA-supported laws to cut back on administrative burdens and care delays from prior authorization requirements.