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MGMA meets with CMS Administrator on prior authorization

Washington Connection

Medicare Payment Policies

Federal Compliance

Nov. 13, 2019: A small group of leading healthcare organizations, including MGMA, American Medical Association, American Hospital Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association were invited to meet with top officials of the Centers for Medicare & Medicaid Services (CMS), including Administrator Seema Verma, to discuss prior authorization challenges. With MGMA members ranking prior authorization as their leading administrative burden, Anders Gilberg, Senior Vice President of MGMA Government Affairs, took the opportunity to advocate for reducing the overall volume of authorization requirements through gold carding and eliminating authorizations for routine services with high health plan approval rates. He also emphasized to CMS the need to standardize health plan medical necessity requirements, called for transparency of health plan approval rates by service and provider, and encouraged automation of prior authorization processes by leveraging national standards for electronic transactions and electronic clinical documentation attachments.
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