A CMS pilot program that would add prior authorization for some traditional fee-for-service Medicare services has come under increased scrutiny by ...

To control costs, nearly all health insurers use a system called prior authorization, which requires patients or their ...

Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG). The OIG review included ...

There is a striking paradox in the Census findings reported in the article by Kirkwood et al 1 that accompanies this editorial. Nearly two thirds of oncologists cite payer strains as the primary ...

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 ...

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 ...

As congressional Democrats and Republicans battle over how to avert a potential government shutdown, another issue -- reining in prior authorizations -- remains on both parties' radar screens, ...

The COVID-19 pandemic is changing the way healthcare does business – sometimes in temporary ways, sometimes in ways that may suggest permanent change when the crisis has passed. Prior authorizations ...

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 ...

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. My 90-year-old uncle, a retired county employee, has had a ...

If you or someone you know has experienced the frustration of a delayed medical procedure or a denied prescription due to prior authorization, you’re not alone. That’s why Indiana lawmakers are ...

Eye specialists say they are seeking to prevent disruption of patient care from a new Humana Inc policy that delegates review of prior authorization for cataract surgery for its Medicare Advantage ...