Search Results
The default setting for search results displays All Content. If you prefer to see recent content only, please adjust the date filter.
Filter your results:
Types
Topics
28 Results Found
HHS announces initiative with insurers to streamline prior authorizationsÂ
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.
GAO says CMS should target behavioral health services in prior authorization audits
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.
Study finds 90% of Medicaid managed care plans cover at least one AUD medication without priority and quantity limits
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.
Report highlights how health care can avoid $20 billion in spending
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.
KFF: MA insurers made nearly 50 million prior authorization determinations in 2023
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.Â
AHA releases final Health Care Plan Accountability Update for 2024Â
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.
Senate report scrutinizes Medicare Advantage prior authorization denials for post-acute care servicesÂ
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.
GAO report finds lack of oversight on Medicaid managed care plans’ prior authorization requirements for children
A report released May 29 by the Government Accountability Office found a lack of state oversight on Medicaid managed care plans’ use of prio
Increasing Administrative Costs, Burdensome Commercial Insurer Practices Create Patient Care Challenges
There will always be administrative costs associated with operating a hospital.
AHA urges HHS OIG to further scrutinize Medicare Advantage organizations' use of prior authorization for post-acute 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.