CMS will simplify prior authorization process that’s given radiologists headaches for years

The Centers for Medicare and Medicaid Services wants to simplify one burdensome process that’s been frustrating radiologists for years.

Administrator Seema Verma revealed on Tuesday that her agency has pinpointed prior authorization process improvements as a “priority” in 2020. Such rules require docs to check first whether an insurer covers an imaging exam or other service, often leading to paperwork, delays in care and provider burnout.

During a speech at the American Medical Association’s National Advocacy Conference Feb. 11, Verma labeled this “longstanding problem” in healthcare “indefensible” as it currently stands.

“Patients are frustrated and doctors are sick of pointlessly wrangling with insurance companies,” she told MDs gathered in Washington, D.C. “Prior authorization requirements are a primary driver of physician burnout, and even more importantly, patients are experiencing needless delays in care that are negatively impacting the quality of care they receive.”

The CMS chief stopped short of calling for an end to prior authorization, instead characterizing it as “an important utilization management tool,” and did not offer concrete specifics on next steps. But Verma believes automation will finally begin to clear up some of these issues. CMS has already conducted 35 listening sessions with providers, she added, and gathered 2,000-plus comments, she added.

“We appreciate all of your input,” Verma told attendees. “The Trump administration is once again ready to take action to support doctors and patients. We will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”

One recent analysis estimated that the cost for physicians to manually generate a prior authorization increased 60% between 2018 and 2019. At the same time, the insurer price tag for that transaction decreased. The Medical Group Management Association—which represents 55,000 practice leaders across the U.S., including radiologists—said it was “alarmed” by the findings, and urged CMS to address this pain point.

“The financial burden of prior authorization requirements on physician practices is increasing at an alarming rate,” Anders Gilberg, senior VP of government affairs, said last month. “In 2020, practices should not be forced to rely on fax machines to complete manual prior authorizations when health plans could modernize the process.”