MedPage Today January 7, 2025
— No, say some physicians and advocacy groups
The new CMS regulations on prior authorization have been heralded as a big step forward in reducing administrative burdens on physicians, but some people think it doesn’t go far enough.
The CMS regulations, which were issued last January, require federally regulated health plans to “improve the electronic exchange of health information and prior authorization processes for medical items and services,” according to a CMS press release. For example, starting next year, affected plans must send prior authorization decisions within 72 hours for urgent requests and 7 calendar days for non-urgent requests. The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, and payers must...
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