Mandated, payer-directed prior authorization for diagnostic imaging and medications is a great barrier to patient access in today’s cardiovascular practice landscape. The College is committed to driving prior authorization reform to improve patient care and reduce administrative burden.
The College's prior authorization reporting tools collect data from pre-authorization requestors on disputed prior authorization requests and denials to establish trends of inappropriate prior authorization decisions.
- Complete the Cardiac Procedures Prior Authorization Reporting Tool
- Complete the PCSK9 Prior Authorization Reporting Tool
Principles For Prior Authorization Reform
Building from a list of goals developed by an AMA-led coalition, the ACC supports the following refined prior authorization principles centered around transparency, standardization and efficiency.
- Define "selective application of prior authorization" to mean review and authorization for coverage of a test or treatment where appropriate for requests not covered by Appropriate Use Criteria (AUC) or guidelines. Prohibit procedure and medication substituting by payers consistent with AUC and guidelines.
- Allow for "prior authorization program review and volume adjustment," so payers and contracted benefit managers can authorize requests for tests and treatments from providers or practices that demonstrate compliance with established AUC and guidelines.
- Require payers to make rates of allowed and denied procedures available to consumers.
- Avoid interruption in care by allowing patients granted coverage for a given treatment under one payer to transfer that coverage to another payer.
- Establish online standardized prior authorization tools and criteria for providers and their practice staff.