CMS Prior Authorization Rules: Tactics to Fight Back and Win

Originally focused on the costliest types of care, Payors now commonly require Prior Authorization for many mundane medical encounters, including basic imaging and prescription refills. Thus, PA is no longer used as a method to limit wasteful use of resources, but rather may be used as a tool that prevents patients from getting the vital care they need.

CMS recently finalized the Interoperability and Prior Authorization Final Rule. This final rule establishes requirements for Payors to streamline the prior authorization (PA) process. While prior authorization can help ensure medical care is necessary and appropriate, providers have been vocal that it is often an obstacle to necessary patient care when providers are forced to navigate complex and widely varying Payor requirements or face long waits for decisions. Beginning primarily in 2026, impacted Payors will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. While these future requirements will be critical in expediting Payor decisions related to patient care, there are techniques that providers can utilize today to help reduce their prior authorization burdens without compromising patient care.

Webinar Objectives

PA can delay treatment and impact optimal patient health outcomes. To reduce these negative consequences for both patients and physicians, practices can minimize the impact of PA in their operations by developing efficiencies and implementing best practices to navigate the dizzying landscape of Payor PA rules.

Webinar Highlights

• Understand CMS Final Rule and what it means for Providers
• Understand ways to reduce the prior authorization burden
• Understand practice operations that can make your prior authorization process more efficient
• Understand the advantages and disadvantages of the myriad Prior Authorization submission methods
• Understand the procedures and medications that likely to trigger prior-authorization requirements 
• Understand how to respond to an inappropriately denied prior authorization

Who Should Attend

• Medical Directors
• Practice Administrators
• Prior Authorization Specialists
• Medical Assistant
• Medical Coder
• Provider Groups
• Management Service Organizations (MSOs)