Maverick's Update

Quietly, and at an unknown date and time, CMS slipped in an update to its FAQs to answer a truly frequent question: Where the heck is the final rule on prior authorization that is part of the interoperability rules? You know, the one that says health plans have to streamline the prior authorization process…so doctors and patients know what documentation they need to show to get a medical service paid for? This get-permission-before-getting-medical-care process is a long-time pain point for patients and their doctors. But without it, health plans (who are supposed to be paying for only medically necessary services) might as well just send doctors a blank check with a post-it note that says “sky’s the limit!” So, if this is an important check and balance to make sure requested medical services are necessary, then where is the prior authorization final rule that is supposed to streamline this process? The CMS Answer: Ron Klain told us to withdraw it because it wasn’t published in the Federal Register yet before the Biden Administration took office. Um, OK. But out of R-E-S-P-E-C-T for patients and doctors and those industry players who are trying to implement dramatic operational changes to improve the system, maybe provide at least a timeline for the prior authorization requirements? Everyone knows it is coming, just like everyone knew that Aretha would finally get her props, but when?