Conflicting rules governing patient data exchanges during prior authorization reviews need to be reconciled to avoid confusion and higher costs, a coalition of healthcare industry groups wrote the Centers for Medicare and Medicaid Services on Wednesday.
The American Hospital Association, the American Medical Association, the health insurance association AHIP and the Blue Cross Blue Shield Association urge CMS Administrator Chiquita Brooks-LaSure to clear up a mismatch between two proposed rules published in December that mandate different data exchange standards.
One draft regulation would require health insurers and providers to comply with one specific set of electronic data-sharing standards when sending healthcare attachments during payment disputes, claims reviews and preapproval requests. A second proposed rule dictates different requirements for how government-sponsored insurers must share patient information when processing prior authorization requests.
"We are concerned by the conflicting provisions of these [notices of proposed rulemaking] that would establish two different sets of standards and corresponding workflows to complete the [prior authorization] process, depending on the type of health plan. Moreover, for federally regulated plans, this would require cross-walking the two standards for no disceriable benefit," the organizations wrote. The proposed rules would "create the very same costly burdens that administrative simplification seeks to alleviate," they added.
CMS touted the regulations as efforts to streamline communications between insurers and providers by eliminating the need to use fax machines and to save $454 million a year in administrative spending. CMS did not immediately respond to a request for comment.
Separately, the AMA, AHIP and the National Association of Accountable Care Organizations issued recommendations Tuesday for how patient data should be shared among participants in value-based care arrangements.