Why Prior Authorization Still Matters When you join a Medicare Advantage plan, your care sometimes requires an extra step ...

Prior authorization has been a bone of contention between payers and providers for some time now. Payers argue that it helps avoid unnecessary care and reduces costs, while providers say it creates ...

The new CMS regulations on prior authorization have been heralded as a big step forward in reducing administrative burdens on physicians, but some people think it doesn't go far enough. The CMS ...

The requirement that physicians get prior authorization from insurers before providing a medical service, diagnostic test or medication may be the greatest single bottleneck for the delivery of ...

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist ...

In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

New technology and frameworks have helped create new opportunities for hospitals to automate and control previously ...

A report by the Office of Inspector General (OIG) finds Medicaid managed care members may not be receiving all medically necessary services. Medicaid managed care organizations (MCOs) denied one out ...

GI docs say the payer is using AI to move large volumes of services through prior authorization. Effective June 1, UnitedHealthcare will require prior authorization for nearly half (47%) of ...

Doctors say that the process too often leads to delays in patient care and sometimes causes consumers to abandon treatment. Beginning in June 2023, health plans in Michigan will have to act on ...

Medicare Advantage plans' use of prior authorization is raising some eyebrows at the Office of Inspector General. A new report (PDF) from the Department of Health and Human Services OIG found that MA ...

Prior authorization can help encourage the efficient use of health care resources but too often, it delays treatment patients ...