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

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 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 ...

Prior authorization of drugs, diagnostic testing, or other medical services “is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a ...

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 ...

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 ...

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 ...

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 ...

Different categories of health insurance are governed by different agencies and are therefore subject to different prior authorization rules. For example, federal marketplace plans, as well as ...

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, ...