As its days dwindle down, the Trump administration proposed regulatory changes designed to ease prior authorization rules and improve provider and patient access to medical records. Specifically, the Center for Medicare and Medicaid Services (CMS) proposed rule would Medicaid, the Children’s Health Insurance Plan (CHIP), Qualified Health Plans (QHPs) and other payors to build application program interfaces to support prior authorization and data exchange. Here is a quick briefing on the 347-page rule. The Diagnostic Challenge Payors rely on prior authorization requirements to ensure program integrity and winnow out medically unnecessary laboratory tests and other covered health services. However, these requirements are administratively burdensome and time consuming. The all too frequent result is not only significant inconvenience but also harm to patients. In 2018, the healthcare industry issued a consensus statement stressing the need for reform. But those calls seem to have gone unheeded. In a June 2020 American Medical Association (AMA) survey, more than 9 in 10 physicians said that prior authorization rules regularly delays patient access to medically necessary care. Nearly one in four physicians reported that at least one of their patients had suffered a serious adverse event as a result of prior authorization rules. Another 16 […]