In responding to an ONC task force draft report about clinical integration and reducing administrative burden in healthcare, Medical Group Management Association calls for additional steps to reduce the administrative burden of prior authorizations.
The Medical Group Management Association (MGMA) is calling on the Office of the National Coordinator for Health Information Technology (ONC) to take additional steps to reduce the administrative burden of prior authorizations.
In responding to an ONC task force draft report about clinical integration and reducing administrative burden in healthcare, the MGMA commends some of the recommendations but indicates that they don't go far enough.
"[W]e suggest that several of the recommendations would benefit from including additional specificity and we contend that moving the needle on prior authorization will require federal government mandates on health plans," it said in a comment letter.
It said the ONC should work toward three main goals:
· Reducing the overall volume of prior authorization requirements
· Increasing health plan requirement transparency
· Identifying opportunities to automate prior authorization transactions
The MGMA's comments also included several specific suggestions for how this might be accomplished, while also pointing out where the draft recommendations fall short. Among them:
· Put more focus on opportunities to reduce the overall volume of prior authorizations through actions like eliminating the authorization requirement for routine services and by implementing “gold card” programs for high-performing practices
· Include additional commercial and federal health plan transparency requirements, including requirements to publish metrics on services that are frequently approved, authorization and denial rates, rates of appeal, and others
· Issue regulation establishing a national standard for electronic attachments to help streamline the submission of clinical documentation in support of a prior authorization
· Do not require the patient be responsible for conducting prior authorization transactions
· Encourage stakeholders to test innovative prior authorization solutions and provide financial support for that work from the federal government
· Enforce health plan non-compliance with federal regulations, which MGMA says is a contributing factor to the administrative burdens experienced by providers
Read the full letter here.
Alexandra Wilson Pecci is an editor for HealthLeaders.