Prior authorization can help encourage the efficient use of health care resources but too often, it delays treatment patients urgently need. A new framework offers a middle path: applying prior ...
The aggravating prior authorization process includes one step that merits scrutiny and potentially regulatory action: the ...
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 ...
Prior authorizations are hazardous to patients’ health, according to more than one-quarter of physicians. In a survey (PDF) by the American Medical Association, 28% of 1,000 responding physicians said ...
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 ...
In recent years, there has been a growing trend on the part of Medicare and Medicare Advantage plans to require prior authorization for a wide range of medical services. Though a physician or other ...
Objective: To evaluate the effectiveness of an automated prior authorization (PA) system (SmartPA) in reducing use of and expenditures for cyclooxygenase-2 (COX-2) inhibitors. Study Design: Before and ...
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 ...
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Understanding Medicare Advantage Prior Authorization
Why Prior Authorization Still Matters When you join a Medicare Advantage plan, your care sometimes requires an extra step ...
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