The reintroduction of the "Improving Seniors' Timely Access to Care Act" marks a critical step toward modernizing the prior authorization process within Medicare Advantage plans. So, what does this mean for patients and providers moving forward?
About 7.4% of prior authorization requests submitted to MA insurers were denied in 2022, according to a recent KFF report. Of these denials, only 9.9% were appealed.
Break down the silos. Take control of your provider data.
As the industry embarks on this fundamental transformation, a few key questions must be answered.
Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.
As the role of AI in healthcare settings continues to evolve and generate debate, here are seven things to keep an eye on.
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Neurologists and health care practitioners must evolve with the world. Telemedicine carts assist in this evolution by serving as an intermediary between patients and doctors.
AI can improve the prior authorization process, but there needs to be more transparency, experts said during a recent panel held by KFF.
CMS finalized a rule on Wednesday that included set deadlines for affected payers to complete prior authorization requests. Several organizations came out in support of the rule.
The real-time, automated nature of green lighting offers precise control without the setbacks or manual efforts inherent to conventional gold carding programs. This innovative new approach also ensures adherence to state-level and other gold carding regulations
Nearly half of physicians are equally excited and concerned about the use of AI in their field, according to a new AMA survey. Those who felt optimistic about AI cited reduced administrative burden as the number one benefit they’re seeking. Patient privacy and the impact to the patient-physician relationship were the most common reasons physicians cited for having reservations about AI.
At a time when AI is reshaping pharma, Reverba Global CEO Cheryl Lubbert explained in an interview why empathy, context, and ethics still require a human touch.
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 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.
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 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.
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.