Could Proposed CMS Prior Authorization Rule Reduce Provider and Patient Burdens?

Prior authorization is an acknowledged source of frustration for providers and patients, creating administrative hassles and sometimes causing delays in care. In an initiative that builds on the Interoperability and Patient Access final rule published in May, The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would improve the electronic exchange of healthcare data among payers, providers, and patients, and streamline processes related to prior authorization.

According to the news release, payers would be required to implement and maintain these APIs using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard, "an innovative technology solution that helps bridge the gaps between systems so both systems can understand and use the data they exchange."

This new proposed rule builds on earlier work completed by the administration, including the Interoperability and Patient Access rule that was finalized this spring.