{"id":441661,"date":"2023-01-30T01:54:56","date_gmt":"2023-01-30T06:54:56","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=441661"},"modified":"2026-03-13T02:09:37","modified_gmt":"2026-03-13T07:09:37","slug":"hospital-prior-authorizations-2023","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/hospital-prior-authorizations-2023\/","title":{"rendered":"8 updates for Hospital Prior Authorizations in 2022 Implemented from January 2023"},"content":{"rendered":"

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8 Prior Authorizations Updates for Hospital<\/b><\/span><\/h2>\n


\nThere have been several updates and developments related to streamlining the prior authorization process in the healthcare industry in 2022, making it complicated for hospitals and health systems. These updates include:<\/span><\/p>\n

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  1. The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to streamline the process and estimates that it will save hospitals and medical practices over <\/span>$15 billion<\/span><\/a><\/span> over a decade.<\/span><\/span><\/li>\n
  2. The Governor of Pennsylvania signed a law that requires insurers to provide timely approval for non-urgent and emergency healthcare services before they are rendered and to conduct peer reviews by specialists if the necessity of a service is questioned.<\/span><\/li>\n
  3. Blue Cross Blue Shield of Massachusetts, Florida Blue, and other payers implementing strategies to reform their prior authorization systems.<\/span><\/li>\n
  4. The effects of a Texas law coming into effect, which exempts physicians with a 90% approval rate for certain services from prior authorization requirements for those services.<\/span><\/li>\n
  5. The U.S. House of Representatives passed a bill to reform the Medicare Advantage prior authorization process, which is still under consideration in the Senate.<\/span><\/li>\n
  6. The Office of the Inspector General for the Department of Health and Human Services released a report finding that some Medicare Advantage Organizations delayed or denied access to services even though the requests met coverage rules.<\/span><\/li>\n
  7. Four revenue cycle leaders share their ideas for changing the prior authorization process.<\/span><\/li>\n
  8. The Governor of Michigan signed a bill that shortens the time insurers have to consider prior authorization requests and requires them to provide more information about the process to the public and providers.<\/span><\/li>\n<\/ol>\n

    Centers for Medicare and Medicaid Services has put forward a new rule that aims to increase access to healthcare information and streamline the prior authorization process:<\/b><\/span><\/h3>\n

    The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that aims to improve patient and provider access to health information and streamline prior authorization processes for medical items and services. The rule would require certain payers to adopt an <\/span>electronic prior authorization system<\/span><\/a><\/span>, reduce the timeframes for responding to prior authorization requests, and establish policies to make the process more efficient and transparent. It also proposes to require certain payers to implement standards for data exchange between payers when a patient changes coverage or has concurrent coverage, which is intended to help ensure complete patient records are available during transitions between payers. This proposal is part of the Biden-Harris Administration’s efforts to increase health data exchange and invest in interoperability.<\/span><\/span><\/p>\n

    Some of the key takeaway points for this effort are:<\/strong><\/span><\/h3>\n