A policy aiming to save Medicare money has not had the intended effect on outpatient surgery. As the policy expands across the country, researching the results of this policy could inform how ...

Prior authorization delays and standardized codes that do not measure case variability are just two orthopedic policy ...

Medicare beneficiaries in 10 states will soon be participating in a new prior authorization program. The Centers for Medicare & Medicaid Services (CMS) is implementing a five-year demonstration ...

For beneficiaries in six states, AI could decide on some Medicare claims for non-emergency health care services.

For the most part, Keyanna Jones and her husband thought they knew what to expect when their daughter Chloë had eye surgery last fall. Even Chloë, who was in kindergarten, had a good understanding of ...

Please provide your email address to receive an email when new articles are posted on . HHS and CMS recently announced insurers have pledged to voluntarily reduce prior authorizations. Questions ...

Payers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management. Like many others, I was drawn to be a doctor because I ...

"Medically necessary" is often a four-letter word for patients.

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 ...

Please provide your email address to receive an email when new articles are posted on . Patients who required prior authorization had increased costs in the year prior to TKA. Prior authorization was ...

A new policy increased wait time for patients, but didn't speed up the move from hospital-based to outpatient-based operations. A new policy increased wait time for patients, but didn’t speed up the ...