Reducing Administrative Burden in Healthcare: The American Hospital Association Urges Congress to Simplify Prior Authorization Processes in Medicare Advantage

On May 8th, the American Hospital Association (AHA) presented a statement to the Senate Budget Committee regarding the reduction of administrative burden in health care. The AHA urged Congress to simplify and streamline the prior authorization process in Medicare Advantage (MA). The organization emphasized that these processes not only put financial strain on the healthcare system but also contribute significantly to provider burnout.

Surgeon General Vivek Murthy recently issued an advisory highlighting the negative impact of burdensome documentation requirements, including prior authorization, on health care worker burnout. In response, the AHA has recommended several actions for legislators to take in order to address these issues.

Firstly, the AHA called for making prior authorization requirements more uniform across all states and plans. Secondly, more frequent audits of MA plans with a history of inappropriate denials should be conducted. Thirdly, a provider complaint process should be established for violations of these requirements. Fourthly, penalties should be enforced for non-compliance by both plans and providers. Lastly, clarification is needed on states’ roles in oversight to ensure consistency across all regions.

In addition to these recommendations, the AHA also expressed support for legislation that supports gold carding programs and endorsed CMS’s proposed rule to standardize claims attachments under HIPAA. By implementing these changes, the AHA believes that the administrative burden in health care can be significantly reduced, leading to a more efficient and effective system for both providers and patients.