AMA Advocates for 24/7 Prior Authorization Processing
By Joey Berlin

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The American Medical Association House of Delegates once again tackled onerous, care-impeding prior authorization requirements.

This time, delegates at the Special Meeting discussed and passed new policy on Tuesday that advocates for insurers and benefit managers who require prior authorization to have staff available to process  those approvals 24 hours a day, year-round, “including holidays and weekends.”

One proposed amendment, ultimately rejected, would have curbed the policy to targeting only “urgent/emergent clinical/administrative” prior authorizations. San Antonio internist Jayesh Shah, MD, was one of several house members to speak against that amendment.

“We have the statistics that prior authorization delays proper care, causes harm, and my patients suffer every day because of inadequate work by these insurance companies,” Dr. Shah testified. “Insurance companies make enough money, and they can provide this 24/7 service. It should not be just limited to urgent and emergent. It should be for every prior authorization. They should provide 24/7 care, period.”

Among its other business, the house adopted new policies on economic discrimination that:

  • Actively oppose policies limiting physician access to hospital services based on quantity and type of referrals, number of procedures performed, their use of hospital services, or employment affiliation; and
  • Recognize that credentialing, physician onboarding, and peer review should “not be tied in a discriminatory manner to hospital employment status.”

Delegates also approved new policies aimed at mitigating the negative effects of high-deductible health plans. Those measures call on AMA to encourage “ongoing research and advocacy to develop and promote innovative health plan designs;” push employers to give patients “robust education” to help them make good use of their plan benefits; and encourage state and national medical associations and specialty societies “to actively collaborate with payers” in innovative plan designs.

Last Updated On

November 19, 2020

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Joey Berlin

Associate Editor

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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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