National health care groups propose ways to cut #8220pre-approval#8221 times

The groups are the American Hospital Association, Americas Health Insurance Plans, American Medical Association, American Pharmacists Association, Blue Cross Blue Shield Association and the Medical Group Management Association.

Those groups say that the process in which patients must get pre-approval from their insurance companies to pay for expensive medical treatments is cumbersome and time consuming for health care providers and insurance companies, and sometimes results in a denial of coverage.In a consensus statement, those groups have pledged to work on:

Reducing the number of health care professionals subject to prior authorization requirementsbased on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider;

Regularly review the services and medicationsthat require prior authorization and eliminate requirements for therapies that no longer warrant them;

Improve channels of communicationsbetween health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes;

Protect continuity of carefor patientswho are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements, and

Accelerate industry adoptionof national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

Tom Nickels, executive vice president of the AHA, said in a written statement, These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden. Copyright 201 BridgeTower Media. All Rights Reserved.

CREDIT: Vince Calio