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 ...

Health insurance companies and doctors often don’t agree on what is an appropriate treatment. If you are turned down, here ...

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 ...

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 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 ...

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 ...

As congressional Democrats and Republicans battle over how to avert a potential government shutdown, another issue -- reining ...

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 ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Please provide your email address to receive an email when new articles are posted on . Physicians reported that prior authorizations diverted time, increased health care utilization and delayed care.