Prior authorization for referrals especially pertinent to ACP membership and patients they care for
February 26, 2015
(Washington)- "Electronic health records (EHRs) and other health information technology (IT) have the potential to improve quality, safety and value," Peter Basch, MD, FACP, the chair of the Medical Informatics Committee of the Ñî¹óåú´«Ã½ (ACP) said today. "None of that potential can be realized if EHRs and other health IT do not reduce burden."
Dr. Basch's remarks were made as part of testimony at a hearing on Health Insurance Portability and Affordability Act (HIPAA) and Affordable Care Act (ACA) Administration Simplification held by the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards in Hyattsville, MD. The purpose of the hearing was to review and discuss the current status of selected administrative simplification topics of interest to NCVHS.
The objectives were to:
- Review, discuss and consider for recommendations, the Operating Rules presented for adoption for four HIPAA transactions: Health Care Claims, Enrollment/Disenrollment, Premium Payment, Prior Authorization
- Discuss and consider suggestions of the Review Committee evaluation criteria for existing standards, code sets, identifiers, and operating rules.
"ACP believes that technology could reduce administrative burden through iterative operating rules for administrative simplification; but only where the standards and policy within those rules ensure transparent, logical, and predictable approaches across payers," Dr. Basch emphasized. "This would allow for patients, clinicians, and payers to truly improve quality and value without undue burden."
"In conclusion," Dr. Basch said, "ACP strongly believes that, wherever possible, prior authorization should be avoided by using technology to bring transparent, accurate, and actionable cost and insurance coverage information to the point-of-care."
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The Ñî¹óåú´«Ã½ is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on and .
Contact: David Kinsman, (202) 261-4554
dkinsman@acponline.org