2024 Final CMS Prior Auth Rule Explained

PrescriberPoint Team Date: 02/12/2024

Key Impacts of the CMS Final Rule


The Centers for Medicare & Medicaid Services (CMS) has released the Interoperability and Prior Authorization Final Rule (CMS-0057-F), aiming to modernize the healthcare system and alleviate the burden on patients, providers, and payers by streamlining the prior authorization process. As advocates for streamlined healthcare, we’re excited to share this news and educate you on how this will impact the prescribing process.

Here are the key impacts of the CMS final rule:

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3 key impacts of the CMS final rule

1. Accelerated Approvals: Expedited prior authorization decisions within 72 hours for urgent requests ensure timely access to necessary medical items and services, reducing patient wait times and improving overall care efficiency.

2. Transparent Denials with Reasons: Payers are now required to provide specific reasons for denying a prior authorization request. This transparency empowers providers, facilitates quick resubmission or appeal, and enhances the overall understanding of the decision-making process.

3. Efficiency through Digital Transformation: Introduction of the Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Prior Authorization API automates and streamlines the electronic prior authorization process. This digital transformation reduces administrative burdens, empowers clinicians, and prevents avoidable delays in patient care.

Conclusion

In a nutshell, CMS's rule is reshaping prior authorization, enhancing access to health information, and ultimately working towards better patient care. We’re looking forward to continuing to push the needle forward when it comes to a more efficient prior authorization process and supporting timely, high-quality care.

 


 

About PrescriberPoint

At PrescriberPoint, our primary objective is to alleviate the administrative load of starting therapies for patients on healthcare providers like yourself, enabling you to focus on providing top-quality care to your patients. We achieve this goal by providing a centralized platform where prescribing and coverage information, prior authorization forms, patient assistance and education materials are readily accessible in one place, eliminating the need for time-consuming individual searches and providing healthcare providers with multiple options to submit forms.