News & Insights

MGMA applauds release of joint statement on improving the prior authorization process

Press Release

Government Programs

Washington, D.C., Jan. 17, 2018– Prior authorization, one of the most burdensome administrative requirements faced by medical group practices, is being addressed by a collaborative of leading healthcare organizations, including the Medical Group Management Association (MGMA). Requests made to health plans for approval to provide medical services or prescribe medications, has long been one of the most onerous tasks conducted by practice staff. The collaborative released a joint statement in an effort to solve some of the most pressing concerns associated with prior authorization.

As earlier MGMA research has shown, the number of health plan authorizations have been increasing, despite the fact that the overwhelming percentage of requests are ultimately approved. “Meeting health plan proprietary authorization requirements consume significant time for both clinical and administrative personnel, diverting staff away from providing direct patient care, and costing practices countless dollars to administer,” stated Anders Gilberg, MGMA Senior Vice President, Government Affairs. “Most importantly, the prior authorization process can result in delayed or denied patient care.”

In addition to MGMA, the collaborative included American Hospital Association, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association, and the Blue Cross Blue Shield Association. The joint statement focuses on five areas: Selective Application of Prior Authorization; Prior Authorization Program Review and Volume Adjustment; Transparency and Communication Regarding Prior Authorization; Continuity of Patient Care; and Automation to Improve Transparency and Efficiency. Kevin R. Mulcahy, CMPE, Director, Payer Relations & Special Billing, at the Massachusetts General Physicians Organization was the MGMA member representative on the initiative.

“We commend the participating organizations and see this joint effort on prior authorization as an important first step toward fully addressing the many challenges associated with this onerous health plan requirement. We hope that the work of this provider-payer collaborative will act as a springboard for future industry action not just with prior authorization but other administrative challenges as well,” stated Gilberg.

About MGMA

Medical Group Management Association (MGMA) is the premier association for professionals who lead medical practice. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 40,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States.

For additional information or comment, contact: Robert Tennant, Director Health IT Policy, MGMA at rtennant@mgma.org or 202-293-3450
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