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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

February 18, 2020

Group Practice Journal LogoDuring the signing ceremony for the Health Insurance Portability and Account- ability Act of 1996 (HIPAA), President Bill Clinton pointed out that the legislation provides for the development of “national standards for the electronic submission of health insurance claims that will reduce paperwork, administrative costs, and burdens for doctors and hospitals.”

Fast forward two decades to the 21st Century Cures Act, passed in December 2016. Shortly after passage, the HealthIT.gov website posted this explanation: “Under the implementation of the 21st Century Cures Act, the Office of the National Coordinator [for Health Information] (ONC) in partnership with the Centers for Medicare & Medicaid Services (CMS) are charged with documenting the effects of clinician burden and providing suggestions on how to reduce clinician burden.”

Thus, it seems that not much has changed over the past 20 years. Clinicians still face a daunting amount of paperwork—yes, paperwork—related to patient care, prior authorizations, and claims data so they can get paid for the care they deliver.

To read the full article, visit Group Practice Journal.

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