Prior Authorization

How Robotic Process Automation Optimizes Revenue Cycle Management

February 27, 2024 - Revenue cycle management technology comes in all shapes and sizes depending on a healthcare provider’s goals. One of the more popular forms of technology in RCM is robotic process automation (RPA). RPA is a technology that leverages bots or programs to imitate how a human would interact with software to complete high-volume, repeatable tasks, such as logging into applications,...

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Provider Groups Say Final Rule Will Relieve Prior Authorization Burdens

by Victoria Bailey

Provider groups are commending CMS for finalizing patient data-sharing policies and prior authorization requirements. The CMS Interoperability and Prior Authorization Final Rule requires Medicare...

Regulatory Burdens in Healthcare Take Away from Patient Care

by Jacqueline LaPointe

Regulatory burdens in healthcare, such as prior authorizations, surprise billing requirements, and audits and appeals, are taking resources away from patient care as practices face more...

Nurses, Physicians Say Health Insurer Policies Restrict Access to Care

by Victoria Bailey

Nurses and physicians see health insurer policies as barriers to patient care, according to data from the American Hospital Association (AHA). Morning Consult conducted three surveys on behalf of AHA...

AMA: US Healthcare System Headed for Success After 2022 Hurdles

by Victoria Bailey

Medicare payment cuts and physician burnout continue to hurt the country’s healthcare system, but federal and state policies implemented in the past year have created a promising path forward,...

AHA: Health Insurer Policies Fuel Physician Practice Acquisitions

by Victoria Bailey

Health insurer policies are increasing administrative burden for independent physician practices, pushing them to seek employment in other settings and fueling physician practice acquisitions, a report...

MGMA: Medicare Advantage Growth Exacerbates Prior Authorization Burdens

by Victoria Bailey

As Medicare Advantage enrollment grows, medical practices are experiencing more prior authorization burdens, including higher administration costs and disrupted workflows, a report from the Medical...

Revenue Cycle Leaders Spend the Most Time on Denials Management

by Victoria Bailey

Denials management and prior authorization are the most time-consuming revenue cycle management tasks for healthcare financial leaders, a survey commissioned by the healthcare operations company AKASA...

What Prior Authorization Changes in MA Final Rule Mean for Providers

by Victoria Bailey

CMS has released its 2024 Medicare Advantage (MA) and Part D Final Rule, which finalized policies on marketing oversight, prescription drugs, and prior authorization processes. Changes to prior authorization policies are particularly...

Provider Org Recommends Changes to MA Prior Authorization Rule

by Victoria Bailey

The American Academy of Ophthalmology (the Academy) has offered recommendations to CMS on the Medicare Advantage prior authorization proposed rule that may help reduce provider burden and improve...

ACR Recommends Changes to Prior Authorization Proposed Rule

by Victoria Bailey

The American College of Rheumatology (ACR) commended CMS for its proposed prior authorization policies but asked the agency to expand its guidance to other utilization management tools and shorten the...

Practices Complete More Prior Authorizations, See More Care Delays

by Jacqueline LaPointe

Practices are completing more prior authorizations compared to last year and seeing more care delays as a result, according to new data from the American Medical Association (AMA). The AMA recently...

AMA Urges CMS to Finalize Medicare Advantage Prior Authorization Reforms

by Victoria Bailey

The American Medical Association (AMA) and 118 other medical organizations have urged CMS to finalize its proposed prior authorization reforms for the Medicare Advantage program. In a letter to CMS...

From AI to Regulation, Making Progress with the Prior Authorization Process

by Jacqueline LaPointe

Prior authorizations are one of the biggest impediments to treating patients, according to Claire Ernst, JD, director of government affairs at MGMA. The Medical Group Management Association, or MGMA, is a trade group representing...

How a Better Prior Authorization Process is Rising from FHIR

by Jacqueline LaPointe

Given the opportunity, most providers would like to set prior authorizations on fire. One accountable care organization based in the Pacific Northwest is doing just that, in a sense, by leveraging a relatively new health data standard to...

Practices Most Frustrated With Prior Auths, Then No Surprises Act

by Jacqueline LaPointe

Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most burdensome...

MGMA Calls for Prior Authorization Reform in Medicare Advantage

by Victoria Bailey

The Medical Group Management Association (MGMA) has urged CMS to implement policies that support prior authorization reform and value-based care contracts within the Medicare Advantage program. MGMA...

Lack of Prior Authorization Reform Escalating Physician Burden

by Victoria Bailey

Prior authorization continues to increase administrative burden for physicians and impede continuity of patient care as health plans are not following their commitment to advance prior authorization...

AHA: Electronic Prior Authorization Implementation Requires Testing

by Victoria Bailey

The American Hospital Association (AHA) has expressed support for electronic prior authorization processes but urged the Office of the National Coordinator for Health Information Technology (ONC) to...

AHA Asks CMS to Waive Medicare Advantage Prior Authorization During PHE

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to work with Congress and require Medicare Advantage plans to waive prior authorization processes during the current and future public health...

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