On Dec. 10, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule citing potential reductions in provider and patient burden by improving prior authorization processes and increasing patient access to electronic health information.  The rule includes five sets of proposals for potential implementation on Jan. 1, 2023, regarding the following:

  • Patient access application programming interface (API)
  • Provider access APIs
  • Documentation and prior authorization burden reduction through APIs
  • Payer to payer data exchange
  • Adoption of health information technology standards and implementation specifications

The proposed rule also contains five requests for information regarding:

  • Methods for enabling patients and providers to control sharing of health information
  • Electronic exchange of behavioral health information
  • Reducing burden and improving electronic information exchange of documentation and prior authorization
  • Reducing the use of fax machines for health care data exchange
  • Accelerating the adoption of standards related to social risk data

Comments in response to the proposed rule can be submitted to CMS until 5 p.m. on Jan. 4, 2021.  AASM staff will review the rule in its entirety and will work with AASM volunteers and leadership to submit comments on behalf of the AASM membership.

Review the CMS proposed rule fact sheet.

Get more coding and reimbursement resources from the AASM.