The Centers for Medicare & Medicaid Services June 27 announced the rollout of a 6-year technology-enabled prior authorization program pilot.
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The Department of Health and Human Services June 23 announced an initiative coordinated with multiple health insurance companies to streamline prior authorization processes for patients covered by Medicare Advantage, Medicaid managed care plans, Health Insurance Marketplace plans and commercial plans.
The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services when auditing Medicare Advantage plans’ use of prior authorization.
A JAMA Network Open study published March 13 found that 90% of Medicaid managed care plans cover at least one alcohol use disorder medication without prior authorization and quantity limits.
The Council for Affordable Quality Healthcare Feb. 11 released a report highlighting how the health care industry can save $20 billion by transitioning from manual to electronic workflows.
An analysis by KFF released Jan. 28 found that Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023. The finding reflects continued year-over-year increases from 2022 (42 million) and 2021 (37 million) as more people have enrolled in MA. KFF also found that in 2023 there was an average of nearly two prior authorization determinations per MA enrollee.
The AHA Dec. 17 released its Health Care Plan Accountability Update, covering the latest developments in Medicare Advantage, legislation and regulation of private health insurers, as well as other resources from the last quarter.
A report released Oct. 17 by the Senate Homeland Security Committee’s investigative subcommittee scrutinizes some of the nation's largest Medicare Advantage insurers for their use of prior authorization and high rates of denials for certain types of care.
The AHA Sept. 17 urged the Department of Health and Human Services’ Office of Inspector General to further scrutinize policies and practices by certain Medicare Advantage Organizations (MAOs) that impede patient access to post-acute care and circumvent rules designed to ensure access and coverage parity between MA and Traditional Medicare.
More than 46 million prior authorization requests were submitted to Medicare Advantage insurers in 2022, according to KFF analysis released Aug. 6 examining data submitted by MA insurers to the Centers for Medicare & Medicaid Services on prior authorization requests, denials and appeals from 2019 through 2022.
UnitedHealth Group Aug. 1 announced the creation of a gold card program for qualified practices. Under the program, the practices that earn gold card status will not be required to submit prior authorization requests for certain medical, behavioral and mental health services.
Data-driven strategies to combat Medicaid managed care organization (MCO) denials and ensure quality health care delivery for Medicaid enrollees.
The AHA submitted a statement July 11 for a Senate Special Committee on Aging hearing on health care transparency and lowering health care costs.
The Department of Health and Human Services July 10 released a proposed rule designed to improve health information sharing and interoperability.
The Department of Health and Human Services’ Office of Inspector General last week announced its intent to investigate Medicare Advantage Organizations’ prior authorization denials for post-acute care after a qualifying hospital stay.
A majority of physicians say the prior authorization process continues to have a negative impact on patient outcomes and employee productivity, according to a survey by the American Medical Association.
The AHA praised House and Senate leaders in letters June 12 for reintroducing the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would streamline prior authorization requirements under Medicare Advantage plans.
Andrea Preisler, AHA senior associate director of administrative simplification policy, Jennifer Cameron, executive director of patient access at Children's National Health System, and David Jacobson, M.D., division chief of blood and marrow transplantation at Children's National Hospital, discuss what the new prior authorization rule means for ensuring clinicians can do what they do best: take care of their patients.
A report released May 29 by the Government Accountability Office found a lack of state oversight on Medicaid managed care plans’ use of prio
In a statement submitted May 8 for a Senate Budget Committee hearing on reducing administrative burden in health care, AHA urged Congress to streamline the prior authorization process in Medicare Advantage.