January 17, 2024
WASHINGTON, DC — Changes adopted today in the CMS Interoperability and Prior Authorization Final Rule will greatly improve the prior authorization process for providers, patients, and plans alike, America’s Physician Groups (APG) said today. APG is a national association representing approximately 360 physician groups with 170,000 physicians providing care to nearly 90 million patients.
“APG’s providers, who are in value-based arrangements and seek to take accountability for costs and quality, believe that prior authorization is critical to reducing low-value health care, which costs money and can be harmful to patients,” said Susan Dentzer, APG’s President and CEO. “At the same time, prior authorization is often a blunt and misused instrument that poses obstacles to patients obtaining necessary care in a timely way. For this reason, CMS’s new requirements for streamlining the prior authorization process, including requiring a 72-hour turnaround for urgent care requests, and a seven-day turnaround for standard care requests, are appropriate and overdue changes, and we salute the agency for making them.”
APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care.
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