Apr 14, 2023 - Health

Electronic health records rule sets up "bridge to nowhere" insurers say

Illustration of a health plus made of binary code slowly fading.

Illustration: Maura Losch/Axios

A Biden administration effort stemming from the 21st Century Cures Act to make health data sharing more transparent is facing pushback from health insurers.

Why it matters: The rule from the Office of the National Coordinator for Health Information Technology aims to get providers and payers to share patient health information in a more seamless way.

  • But health plans say it's a "bridge to nowhere" without a requirement that EHR vendors implement electronic prior authorization.

The details: Prior authorization, the process by which providers get clearance that a service is covered, often still involves time-consuming paperwork such as faxing documents.

  • Insurance companies will have to begin the process of modernizing the process due to other rules the Centers for Medicare and Medicaid Services is finalizing this spring. But they say it will be all be for naught without a parallel requirement for EHR vendors.

Zoom out: CMS' rule aims to digitize the prior authorization process in an effort to streamline negotiations between payers and providers. Insurers will have to implement electronic prior authorization for Medicare, Medicaid and Affordable Care Act exchange plans.

  • CMS estimates these efficiencies will save physician practices and hospitals $15 billion over a decade.
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