Easing Prior Authorization for Medicare Advantage to Boost Health Care Efficiency, Staff Morale

The American Hospital Association (AHA) has called on Congress to streamline the prior authorization process in Medicare Advantage. In a statement submitted on May 8 for a Senate Budget Committee hearing, AHA highlighted that current prior authorization practices not only add financial burden and strain to the health care system, but also result in inappropriate payment denials and increased costs for staffing and technology.

Surgeon General Vivek Murthy recently issued an advisory noting that burdensome documentation requirements, including prior authorization, are contributing factors to health care worker burnout. AHA urged legislators to simplify and standardize prior authorization requirements, conduct more audits on plans with a history of inappropriate denials, establish a provider complaint process for suspected federal violations, enforce penalties for non-compliance, and clarify state oversight roles in Medicare Advantage.

To further reduce administrative burden in health care, AHA recommended adding prompt payment requirements for Medicare Advantage plans when services are provided by in-network providers to enrollees. Plans failing to make timely payments should be subject to interest penalties. AHA also expressed support for legislation promoting gold carding programs and endorsed CMS’s proposed rule to standardize claims attachments under HIPAA. By implementing these measures, AHA believes the administrative burden in health care can be reduced and the system can operate more efficiently.