Prior authorization or PA has always been complex. Playing a pivotal role in the healthcare system, ensuring that patients receive the necessary treatments and services authorization is here to control costs. Even though, the sole purpose of the sleep study pre auth is for the betterment of patient but today is harming them more. With so many requirements, time consuming, authorization today is creating more frustration than ever. This is why the Centers for Medicare & Medicaid Services (CMS) has proposed five key provisions to enhance the prior authorization process, aiming to improve transparency, interoperability, and efficiency in patient care.
- Patient Access API – The first proposed provision requires payers to include prior authorization information in the Patient Access API. This means patients can have secure access to their prior authorization decisions and understand how these decisions impact their care. Furthermore, impacted payers will need to report annual metrics to CMS about patient usage of the Patient Access API, enhancing accountability.
- Provider Access API – The Provider Access API provision necessitates payers to maintain an API that shares patient data with in-network providers. This includes patient claims, encounter data, USCDI version 1 data, and prior authorization requests and decisions. Such access can improve care coordination and support value-based payment models.
- Promoting Interoperability Program and MIPS – CMS is introducing a new measure to evaluate the use of electronic prior authorization processes by healthcare providers under the Medicare Promoting Interoperability Program and the Promoting Interoperability performance category of MIPS. This measure encourages providers to adopt the new APIs, thereby promoting interoperability in the healthcare ecosystem.
- Payer-to-Payer Data Exchange – Under this provision, impacted payers are required to exchange patient data at the patient’s request when transitioning to a new payer. This data exchange includes USCDI version 1 data, claims, encounter data, and prior authorization information. Facilitating this exchange aims to ensure continuity of care and reduce the burden on patients and providers.
- Documentation Requirements – Impacted payers are mandated to publicly disclose their prior authorization criteria, statistics, and practices on their websites. This transparency initiative aims to increase accountability and help both providers and patients better understand the prior authorization process.
Though the CMS proposals is to improve sleep study prior authorization and is a positive step toward enhancing patient care and reducing administrative tension, practices often get confused and over burden.
This is why today to implement these changes effectively; healthcare practices are looking to outsourcing sleep study prior authorization tasks. Outsourcing can provide the expertise, technology, and support needed to navigate the evolving healthcare landscape while ensuring patients receive the care they deserve.
Outsourcing Benefit for Your Sleep Study Prior Auth:
Outsourcing sleep study prior authorization can ensure that the patient’s access to information is efficient and well-documented. The right prior auth expert can help streamline the process, making it easier for patients to access and understand their prior authorization status. In fact, today there is a one RCM destination ‘Sunknowledge Services Inc’ is known for catering to the complex prior auth needs for many. With collaborative approach Sunknowledge not only ensures the efficient sharing of critical data, enabling smoother care delivery but work on 100 % compliance with new measures efficiently. Expert seamlessly integrates electronic prior authorization processes into workflow, the resources further ensures smooth transition of patient information, supporting the continuity of care.
Meeting all your prior auth requirements effectively while promoting transparency and accountability, Sunknowledge is known for 100 % authorization submission on the same day. Closing all your sleep study PA faster and efficiently, Sunknowledge is a one stop outstanding support resolution.
