CMS’ New Rule Aims to Streamline the Prior Authorization Process

Helping to Navigate Regulatory Changes

The AAO-HSN provides comprehensive support to help members understand complex regulatory changes, such as CMS’s new rule, and maximize their impact on practice operations, Mr. DeCabo said. They include:

• Education Resources: The Academy delivers timely updates through OTO News and The ENT Advocate and also maintains detailed resource libraries on its website with templates, checklists, and position statements.
• Direct Support: Its health policy team provides guidance on compliance questions, helps interpret new requirements, and assists with advocacy efforts.
• Peer Connection: Through ENT Connect, its online member forum, otolaryngologists share real-world implementation strategies, troubleshoot challenges, and learn from colleagues who’ve successfully navigated similar changes.
• Advocacy Tools: The Academy equips members with talking points, template letters, and advocacy toolkits to effectively engage their legislators and payers.
• Monitoring Services: The Academy tracks private payer policy changes, prior authorization updates, and submission requirement modifications, and then alerts members about critical developments that could impact their practices.

“This multi-layered approach ensures that no member faces these regulatory changes alone,” Mr. DeCabo said.

Advice on Adoption

For colleagues who are just beginning to prepare to adopt CMS’s new rule, Dr. Brown offers several tips.

• Study regulations thoroughly— Review the new rules in detail and read analytical articles that provide insights into implementation strategies and potential challenges.
• Leverage professional resources—Use educational materials and training programs that might be available through organizations such as AAO-HNS, Administrator Support Community for ENT, the American Medical Association, and the Medical Group Management Association to ensure comprehensive preparation for upcoming changes.
• Engage your operational team early— Work closely with staff to understand how these changes will affect existing workflows and develop adaptation strategies that minimize disruption.
• Map current processes—Document your current prior authorization workflows to identify specific areas that will need modification.
• Connect with insurance carriers— Reach out to carrier representatives to understand their specific rollout timelines, technical requirements, and interface specifications.
• Prepare your MIPS team—Ensure that your MIPS representatives are fully trained on new reporting criteria, with a particular emphasis on electronic prior authorization requirements and documentation standards.

How to Advocate for Improvements

A variety of ways to invoke change exist. The most impactful way is to become involved in the process, Dr. Troublefield said. Start by volunteering at your state’s otolaryngology organization, where many prior authorization issues are tackled. Massachusetts, for example, has devoted an entire subcommittee to this issue.