Healthcare and technology groups want Medicare Advantage plans included in the Centers for Medicare and Medicaid Services’ proposed rule to expand access to health information and improve the prior authorization process.
MGMA, the Medical Group Management Association and WEDI, the Workgroup for Electronic Data Interchange, both said they favor the inclusion of Medicare Advantage plans in the final rule. WEDI would also like CMS to identify opportunities to incentivize commercial payers to support rule requirements, reports Healthcare Finance.
CMS proposes that plans be required to provide specific reasons for prior authorization denials. Both MGMA and WEDI agree plans need a deadline to make prior authorization decisions, but differ on that timeline.
WEDI agrees with the current CMS proposed timeframe of seven days for non-urgent requests and 72 hours for expedited requests, while MGMA wants to see that shortened to 48 hours for standard prior authorizations and 24 hours for expedited prior authorizations.
CMS said its proposed standard is twice as fast as the existing Medicare Advantage response time limit. Read more.
