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CMS Releases Long-Awaited Prior Authorization Rule

Members & Publications

January 17, 2024

On January 17, CMS published its Interoperability and Prior Authorization Final Rule. Once implemented, this rule will require covered payers to establish electronic prior authorization systems, transmit prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests, provide a specific reason for denying prior authorization appeals, and publicly report metrics for prior authorization. The release of this final rule comes after years of advocacy efforts focused on prior authorization reform by the Academy and the Regulatory Relief Coalition, and is a significant win for PM&R physicians and their patients. Learn more about AAPM&R’s advocacy on this issue.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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