MGMA And Coalition Partners Release New Prior Authorization Principles

New prior authorization principles important step in reducing administrative burden, improving patient care

Recently, a coalition of 16 provider organizations, including the Medical Group Management Association (MGMA), released a set o prior authorization principles aimed at reducing the administrative burden associated with receiving approval from a health plans, benefit managers and others to deliver care to patients. The coalition developed a set of 21 principles tackling five broad categories including clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency, and alternatives and exemptions. The goal of the coalition is to shine a bright light on today’s prior authorization requirements and offer tangible recommendations for improving the current process.

“Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications, and medical devices ceaselessly question the judgement of physicians, resulting in less time to treat patients and needlessly driving up administrative costs for medical groups,” said Halee Fischer-Wright, MD, MMM, FAAP, CMPE, MGMA President and CEO. “Most importantly, despite the fact that the vast majority of prior authorization requests are ultimately approved, jumping through these administrative hoops can lead directly to delay or disruption in the delivery of care to the patient. Working together, the coalition has developed a landmark set of principles and I anticipate that this effort will translate directly into a reduction in the waste associated with prior authorization requirements.”

The coalition will seek to work cooperatively with health plans and others to identify opportunities to streamline today’s cumbersome prior authorization environment. Along with MGMA, coalition members include the: American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Society and Washington State Medical Society.

About MGMA
The Medical Group Management Association (MGMA) helps create successful medical practices that deliver the highest-quality patient care. As the leading association for medical practice administrators and executives since 1926, MGMA helps improve members’ practices through exclusive member benefits, education, resources, news, information, advocacy, and networking opportunities, and produces some of the most credible and robust medical practice economic data and data solutions in the industry. MGMA advances the profession of medical practice management with its industry-leading board certification and Fellowship programs through the American College of Medical Practice Executives.

Through its national membership and 48 state affiliates, MGMA represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties, which represent more than 275,000 physicians and more than 46 percent of the healthcare delivered in the United States. MGMA is headquartered in Englewood, Colo., with a Government Affairs office in Washington, D.C.