Reducing Administrative Burden in Healthcare: AHA Calls for Prior Authorization Reform and Standardization

The American Hospital Association (AHA) has submitted a statement to the Senate Budget Committee on May 8 for a hearing on reducing administrative burden in health care. In the statement, AHA called on Congress to simplify and standardize prior authorization requirements in Medicare Advantage. The organization highlighted that current prior authorization practices not only add financial burden and strain to the health care system, but also result in inappropriate payment denials and increased costs for staffing and technology.

Surgeon General Vivek Murthy recently issued an advisory noting that burdensome documentation requirements, including prior authorization, are contributing factors to health care worker burnout. AHA urged legislators to address this issue by simplifying and standardizing prior authorization requirements, conducting more audits on plans with a history of inappropriate denials, establishing a provider complaint process for suspected federal violations, enforcing penalties for non-compliance, and clarifying state oversight roles in Medicare Advantage.

AHA also recommended adding prompt payment requirements for Medicare Advantage plans when services are provided by in-network providers to enrollees. Plans failing to make timely payments should be subject to interest penalties. Additionally, AHA expressed support for legislation promoting gold carding programs and endorsed CMS’s proposed rule to standardize claims attachments under HIPAA. By implementing these measures, AHA believes the administrative burden in health care can be reduced and the system can operate more efficiently.