AHA urges Senate Budget Committee to streamline prior authorization process in hearing on reducing administrative burden in health care

In a statement submitted May 8 for a Senate Budget Committee hearing on reducing administrative burden in health care, AHA urged Congress to streamline the prior authorization process in Medicare Advantage.  
 
“These practices also add financial burden and strain to the health care system through inappropriate payment denials and increased staffing and technology costs to comply with plan requirements,” AHA wrote. “Additionally, plan prior authorization requirements are a major burden to the health care workforce and contribute to provider burnout. In fact, Surgeon General Vivek Murthy, M.D., issued a recent advisory that notes that burdensome documentation requirements, including the volume of and requirements for prior authorization, are drivers of health care worker burnout.”  

AHA urged legislators to make prior authorization requirements simpler and more uniform; conduct more frequent audits to specific MA plans with a history of inappropriate denials or delayed prior authorization response timeframes; establish a provider complaint process for suspected federal violations by MA plans; enforce penalties for MA plans failing to comply with federal rules; and provide clarity on states' role in MA oversight. 

Additionally, AHA urged Congress to add prompt payment requirements for MA plans when services are furnished by in-network providers to enrollees and to subject those plans to interest penalties if they fail to make timely payments. AHA also expressed support for legislation supporting gold carding programs, and CMS’s proposed rule to standardize claims attachments under HIPAA.