Point-of-Care Partners Provides Comments to NCVHS on Prior Authorization Operating Rules

Legislation needed to improve patient access to medical devices, procedures and tests

Feb 29, 2016, 16:54 ET from Point-of-Care Partners

CORAL SPRINGS, Fla., Feb. 29, 2016 /PRNewswire/ -- Point-of-Care Partners, a leading national health information technology (HIT) strategy and management consulting firm, was pleased to submit comments to the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards during the Public Comment for the February 16 hearing on Prior Authorization Operating Rules.

The comments focused on the critical need to advance industry adoption of electronic prior authorization (ePA), also referred to as electronic precertification, for medical devices, procedures and diagnostic tests. Today, medical prior authorization is handled via antiquated, time-consuming paper, fax and phone work flows that can delay patient access to care for days or weeks and create significant administrative burdens for providers and payers.   

To encourage providers and payers to make the technology and workflow changes necessary to implement parallel, workable solutions for medical ePA, Point-of-Care Partners recommended the following:  

  1. Establish incentives for payers to build automated, seamless integration with their medical claims systems, potentially through Medicare Advantage's STARS Performance Measures.  This would link PA with patient satisfaction (and ultimately payment), and provide the impetus for health plans to improve the PA process through electronic means.
  2. Mandate the development and use of fully automated ePA as an operating requirement for Medicare Advantage plans.
  3. Establish incentives for providers to adopt ePA, through the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs). 

"In HIPAA, the Federal government tried to encourage ePA by mandating the use of the X12 278 prior authorization transaction but transaction volume is minimal, at best," said Tony Schueth, CEO & Managing Partner, Point-of-Care Partners and leader of the National Council for Prescription Drug Programs (NCPDP) ePA task group. "What we've learned from our experience with the task group in the ensuing years is that both sides of a many-to-many transaction such as ePA must be motivated to do development and in a similar timeframe."

The company's full comment to NCVHS is available at www.pocp.com/regulatorycommentsandtestimony.html.

About Point-of-Care Partners
Point-of-Care Partners is a health IT management consulting firm with in-depth expertise in ePrescribing, eMedication management, health information exchange, accountable care organizations and multi-stakeholder initiatives and other programs requiring health IT project management. For more information, go to www.pocp.com.

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SOURCE Point-of-Care Partners