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

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 ...

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 aggravating prior authorization process includes one step that merits scrutiny and potentially regulatory action: the ...

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 ...

Many private health insurers require medical providers to get approval before administering treatment, sometimes resulting in delayed or denied care for patients. Now, that tactic, known as prior ...

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 ...

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 ...

My 97-year-old blind mother slipped into dementia last year and now requires full-time assistance in a memory care unit. Her long-term care insurance carrier insists on three-month care updates for ...