Reducing Administrative Burden in Healthcare: AHA Calls on Congress to Streamline Prior Authorization Process in Medicare Advantage

In a statement submitted on May 8 for a Senate Budget Committee hearing on reducing administrative burden in health care, the American Hospital Association (AHA) called on Congress to streamline the prior authorization process in Medicare Advantage. 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. The organization emphasized that these requirements are a major burden to the health care workforce and contribute to provider burnout.

Surgeon General Vivek Murthy recently issued an advisory noting that burdensome documentation requirements, including prior authorization, are contributing factors to health care worker burnout. The American Hospital Association (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.

Furthermore, 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.

In conclusion, reducing administrative burden in healthcare is crucial for improving patient outcomes and ensuring sustainability of healthcare systems. The American Hospital Association (AHA) has made several recommendations aimed at simplifying and standardizing prior authorization requirements