4 changes the American Academy of Ophthalmology seeks in prior authorization rule

The American Academy of Ophthalmology has commented on CMS' proposed prior authorization rule.

The rule aims to improve the electronic exchange of healthcare data by addressing the prior authorization process. 

Here is what the AAO asked CMS for in a March 13 letter the organization shared with Becker's:

1. Ensure accountability by enforcing decision deadlines and publicly reporting denial metrics.

2. Avoid potential administrative burdens for provider practices by removing the Merit-Based Incentive Payment System Promoting Interoperability measure proposal. 

3. Add protections for small and rural practices. 

4. Expand the rule's provisions to other key areas of concern, including health equity, step therapy, and Digital Imaging and Communications in Medicine standards.

The letter stated that the American Academy of Ophthalmology supports CMS' goal of trying to simplify the prior authorization processes. However, the organization is concerned by the request for comments on if and how the approach to prior authorization within the rule could be applied under Medicare fee-for-service. 

"We ardently oppose prior authorization under Medicare fee-for-service and urge CMS to suspend any existing prior authorization policies on services not mandated by legislation," the letter said. "We believe that prior authorization expansion in fee-for-service has the potential to harm Medicare patients' access to necessary care and should not move forward without a specific legislative mandate."

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