Solving the Prior Authorization Problem through Tech

Photo Credit: Jennifer Jennings

Welcome to the Physicians Practice Pearls Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at editor@physicianspractice.com.

In a sea of vendors, associations, organizations, and attendees promising to fix interoperability and advance population health, the Healthcare Administrative Technology Association (HATA) is tackling other issues facing practices at  this year's Healthcare Information Management and Systems Society (HIMSS) conference.

HATA, formed in 2016, is an industry trade group representing practice management vendors. It is aiming to solve the issue of prior authorizations.

Tim McMullen, JD, CAE, executive director of HATA and Brad Lund, the organization’s director of association management, spoke to the Physicians Practice Pearls podcast about the group's origins, its current initiatives, and its efforts in solving the prior authorization problem.

One potential area to improve this process, McMullen said, is better integration.

"One of the big complaints [we hear] is the integration between the EHR and the [practice management] PM system. You still need the PM system because the prior authorization goes through the PM system, but it's pulling data from the EHR. That technology, even though many people say it's there, it's not quite there," said McMullen. Better facilitation of that transaction could potentially help solve the prior authorization problem.

Later in the podcast, McMullen detailed HATA's efforts in working with CMS and the National Committee on Vital and Health Statistics (NCVHS) to create a predictability roadmap. The roadmap will look at what's feasible for health IT vendors to adopt in the next few years in terms of compliance standards. 

"We had the switch from 4010 to 5010, then it was ICD-9 to ICD-10, and then Meaningful Use. It was just piled on. The technology companies were going crazy; their clients were going crazy. NCVHS took a step back and said, 'Maybe we need to have a plan of how to do this,'" said McMullen.

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