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AMA Pushes for Legislative Remedy to Reform Prior Authorization Process

Jan 15

The American Medical Association (AMA) and other organizations have released a consensus statement on improving the prior authorization process for over three years. The organizations represent the hospitals, pharmacists, medical billing specialists, and medical groups with other trade associations like Blue Cross Blue Shield Association and American Health Insurance Plans (AHIP).

Heather McComas explained a recent ReachMD podcast, “Prior Authorization and the AMA’s Push for Reform.” McComas is the AMA’s director of administrative simplification initiatives. The primary purpose of acknowledging this point was the prior authorization needed to reform because it was out of control. 

There are no significant changes yet in the consensus statement. The AMA Fix, a prior authorization campaign, started this campaign on the federal level, and it is speeding up the process of this reform. Furthermore, it will support the resources to reform, l improve the efficiency, and highlight the changes with the help of providing data. 

Chris Sherin stated that, a few months ago, the Improving Seniors’ Timely Access to Care Act (HR 3173) was represented in the U.S. House of Representatives. It has gathered plenty of co-sponsors originating from both ends of the aisle in a short period. It was observed that almost one-fourth of House’s 435 members have agreed and become co-sponsors. According to AMA’s assistant director of congressional affairs, the four lead sponsors of the two bills were physicians. 

Sherin stated that “simplify, standardize and streamline prior authorization for items and services within the Medicare Advantage program. It doesn’t touch on pharmaceuticals, but it very much matches many of the things that are in the consensus statement.”

Sherin had strong faith that the bill was a solid chance to become a law, but these laws should overcome some difficulties. On the other hand, Association and American Health Insurance Plans (AHIP) also have some reservations about overcoming the legislative remedy. A Senate companion bill still was represented by D-Ariz., MD, R-Kan., John Thune, R-S.D. Krysten Sinema, Sens. Roger Marshall.

Although prior authorization needs reforms, it plays an integral part in medical billing. If your practice faces issues managing the medical billing and coding process, opt for outsourcing these services from a third party. Such companies have medical billing specialists who take care of every medical billing process, including prior authorization. 

The statement given by Dr. Marshall was, “Having served as a physician in rural Kansas for decades, my top priority has always been to provide quality care to my patients,” Moreover Dr. Marshall said, “This legislation cuts the red tape hindering health care providers across the nation from providing our seniors with quality care on time. The common-sense solutions we are offering were formed in partnership with hundreds of national and state organizations over the last two years, and I am honored to lead this bipartisan, bicameral effort alongside Sens. Sinema and Thune.”

After all these statements, Sherin added, “overall, you’re seeing some strong bipartisan support, and over a two-year Congress, hopefully, good things can happen, and we can get it over the finish line.”

At the state level

The senior legislative attorney Emily Carroll said that the AMA put all efforts to perform with the national medical specialty societies, other stakeholders, and state medical associations to reform prior authorization in state legislatures. Some significant reforms are seen by Georgia, Texas, and Illinois this year. 

Medical societies can use AMA’s model legislation and an issue brief to begin the state's legislative process. This model includes language improvement and addresses the qualifications of people doing the denials and approvals, among other reforms on prior authorizations.

Emily Caroll added, “They need to address prior authorization has become more pressing for physician practices that are getting crushed by administrative requirements left and right.” Moreover, she also stated that “Prior authorization is something that doesn’t have to be happening, especially in the volume that it is happening and is essentially harmful to patients. So, I think state legislatures are recognizing that things have to change here.”

In the ending, Caroll stated that “We’re not asking for prior authorization to go away, but we are asking for it to be reduced and streamlined to decrease these delays in care and all the harm that’s associated with those delays and denial.” “That’s where our reform efforts are focused, and we’ll continue to work hard to push for that kind of change.”