With the goal of improving patient data exchange, interoperability, and clinical workflows, CMS recently announced a new rule to streamline prior authorization, which will potentially lighten clinician workload.

Prior authorization is an administrative process used in healthcare for providers to request approval from payers to provide a medical service, prescription, or supply, which all takes place before a service is rendered.

According to this recent EHR Intelligence article, completing prior authorization can be demanding for providers and lead to delays in patient care access, with 46 percent of clinicians submitting authorization requests by fax and 60 percent made over the telephone. The article also highlighted how electronic prior authorization is becoming more prevalent in the medical field.

“Prior authorization is a necessary and important tool for payers to ensure program integrity, but there is a better way to make the process work more efficiently to ensure that care is not delayed and we are not increasing administrative costs for the whole system,” Seema Verma, administrator of CMS, said in a statement.

With better health data interoperability in mind, the proposed rule would force Medicaid, CHIP, and QHP programs to develop application programming interfaces (APIs) to back patient data exchange and prior authorization. For payers, this would mean integrating the APIs using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard.

As a result, payers, providers, and patients would gain more access to information, including past and pending prior authorization decisions, which would reduce administrative burden, cut costs for providers, and boost patient care.

RosettaHealth can assist with any health information challenges you might have, book a free consultation with one of our interoperability experts.