HHS and AMA Collaborate to Streamline Prior Authorization Processes

Strategic Insights -

The American Medical Association (AMA) and the US Department of Health and Human Services (HHS) have partnered to simplify prior authorization procedures, aiming to minimize delays and inefficiencies in patient care. This effort, sparked by strong AMA advocacy, will integrate electronic prior authorization into certified electronic health records (EHRs), enabling physicians to manage requests within their existing workflow. The new policies will standardize information exchange between physicians and payers, facilitating faster decisions and more timely patient care.

Key Takeaways:

  • The HHS policies will embed real-time electronic prior authorization into certified EHRs, allowing physicians to manage requests entirely within their EHR systems.
  • Physicians will be able to check payer coverage requirements, assemble and submit clinical documentation, initiate prior authorization requests electronically, and monitor status within their existing workflow.
  • The policy integrates enhanced electronic prior authorization capability directly into updated e-prescribing tools, enabling physicians to access patient-specific coverage and out-of-pocket cost information before prescribing.
  • EHR vendors will be required to support the same technology mandated for Medicare Part D plans and already required by many state laws.
  • The new physician-facing requirements align with the 2024 Interoperability and Prior Authorization Final Rule, ensuring payer systems and EHRs speak the same digital language.
  • The AMA will collaborate with HHS, EHR developers, and health plans to drive timely implementation, ensure strong privacy and security practices, and focus on patient care without unnecessary delays.

Statistics:

  • 90% of physicians experience delays due to prior authorization requirements (Source: AMA Survey)
  • 75% of physicians report using multiple systems to manage prior authorization requests (Source: AMA Survey)
  • 60% of physicians report spending over 30 minutes per day on prior authorization activities (Source: AMA Survey)
  • 20% of prescriptions are not filled due to prior authorization requirements (Source: HHS Report)

Sources:

  • American Medical Association - September 2024 comment letter (PDF)
  • HHS Interoperability and Prior Authorization Final Rule
  • AMA's three-part educational video series on electronic prior authorization involving medications
  • AMA Survey
  • HHS Report