4 Senators Urge CMS To Collect, Publish More Data on MA Plans
In a letter to CMS, four senators asked for better data collection on the practices of Medicare Advantage plans, including when it comes to prior authorization.
CMS Proposed Rule Tamps Down On MA Predatory Marketing
CMS proposed a new rule that would set a flat amount — $632 — that MA plans can pay agents and brokers when they help enroll a person into any MA plan. The proposed rule also addresses behavioral health access and prior authorization.
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How to Optimize Your Phlebotomy Setup for Efficient Patient Care
The layout of your phlebotomy station can significantly impact efficiency. A well-thought-out setup ensures that every tool is within reach, minimizing unnecessary movement and reducing patient wait times.
3 Tips That Could Reduce Friction in Payer-Provider Relationships
During a panel at MedCity News’ INVEST Digital Health conference, three executives representing a provider, a payer and a technology vendor shared their thoughts on how to heal the rocky relationship between hospitals and health plans. For instance, one leader encouraged payers and providers not to be afraid to give up some control, and another urged them to build comprehensive risk models.
Cigna Cuts 25% of Medical Services from Prior Authorization Requirements
Cigna removed 25% of medical services from prior authorization requirements. This represents more than 600 codes, and includes 100 surgical codes, nearly 200 genetic testing codes, durable medical equipment, orthoses and prosthetics and other services, said Dr. Scott Josephs, chief medical officer of Cigna Healthcare.
Congressman Launches Investigation into Medicaid Prior Authorization Denials
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.
From Bottlenecks to Breakthroughs: Using Technology to Transform Specialty Medication Access and Affordability
We need a streamlined approach where stakeholders can perform all critical tasks — from enrollment and patient consent to prior authorization, from real-time benefit checks to financial assistance — on a central platform powered by a business rules engine, automated workflows, and real-time analytics.
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The Top Surgical Instruments Needed for Extractions
Discover what tools are essential for efficient, safe surgical extractions in today’s health care landscape, from elevators to forceps and beyond.
Medicaid MCOs Denied 1 out of 8 Prior Authorization Requests in 2019
Medicaid managed care organizations deny prior authorization requests at high rates, according to a recent report by the Office of Inspector General. Of the 115 MCOs the OIG analyzed, 12 had prior authorization denial rates above 25%.
Payers Can Reform Prior Authorization to Make it Faster, Smoother But Will It Satisfy the AMA?
In a recent interview, Dr. Jesse Ehrenfeld, the president-elect at the American Medical Association, outlined how the major pain point of physicians has gone from the EHR to prior authorizations requests. But none of the individual efforts that payers are making is enough.
MA Plans Rejected 2M Prior Authorization Requests in 2021
There were more than 35 million prior authorization requests submitted to MA plans in 2021, and 2 million were denied, according to KFF. Of those denied, just 11% were appealed. However, most of those appeals led to the denial being overturned.
5 Ways To Drive Intelligence Into the Prior Authorization Process
It’s time to stop thinking about prior authorizations as a transaction. Rather, PA is the start of a care episode that should be a smooth, well-coordinated journey for patients, their providers and their health plan.
Navigating The Right Steps For Your Healthcare Startup
This webinar will explore how a banking platform approach could be the resource for your company.
Mission (Im)possible: Overcoming the Status Quo In Health Coverage to Offer More Personalization
Remaining at or near the top of employers’ and consumers’ choices when it comes to health coverage will require insurers to make large investments in infrastructure, processes and people to overcome the status quo.
AHA: 78% of Hospitals Say Experience With Commercial Insurers Is Worsening
Less than 1% of hospitals and health systems said their relationship is improving and the rest said it has stayed the same. The American Hospital Association specifically called out commercial insurers for their practices on prior authorization and claims denials and delays.
Senior healthcare advocates applaud House passage of MA prior authorization bill
The bill sets requirements relating to the prior authorization process for Medicare Advantage plans. The House's decision is supported by several healthcare advocacy organizations, including Better Medicare Alliance and the American Hospital Association. AHIP, however, neither criticized nor celebrated the passage.
American Hospital Association turns up the heat on commercial insurers in scathing report
Commercial insurers' practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications at AHIP.
Geisinger Health Plan addresses burdensome prior auth process with Cohere Health’s platform
Geisinger Health Plan is licensing Cohere Health's AI-driven utilization management technology and services platform, designed to support value-based care delivery and streamline the prior authorization process.