Prior Authorization

Health Plan Automates Prior Authorization Process Using AI

by Victoria Bailey

Guidewell, the parent company to health plan Florida Blue, has partnered with an artificial intelligence company to automate the prior authorization process. Florida Blue will become the first payer...

AMA: Prior Authorization Creates Physician Burden, Patient Care Delays

by Victoria Bailey

Prior authorization negatively impacted patients and providers alike by leading to care delays for patients and creating administrative burden for physicians, according to a survey from the American...

Prior Authorizations Beat COVID Workplace as Top Regulatory Burden

by Jacqueline LaPointe

Prior authorizations are troubling medical groups more than regulations governing the workplace during COVID-19 and Medicare’s Quality Payment Program, according to survey results from the...

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care...

AMA Calls for Suspension of Prior Auths During PHEs, Better Peer Reviews

by Jacqueline LaPointe

Payers should temporarily suspend prior authorization requirements during public health emergencies (PHEs), according to a new policy from the American Medical Association (AMA). Physicians have faced...

Prior Authorization Challenges Persist, AMA Survey Reveals

by Jill McKeon

A recent survey from the American Medical Association (AMA) evaluated the challenges and roadblocks of prior authorization (PA) for physicians and patients three years after a coalition of industry...

Coalition Urges CMS to Rethink Medicare Prior Authorization Growth

by Jacqueline LaPointe

A broad coalition of healthcare industry groups is calling on CMS to reconsider Medicare prior authorization growth among outpatient services set to go into effect this summer. The 40 groups...

Prior Authorization Burden Still High Despite COVID Struggles

by Jacqueline LaPointe

Most physicians still faced a high prior authorization burden despite treating a surge of positive COVID-19 cases this winter, the American Medical Association (AMA) reports. In a survey of 1,000...

How a Safety-Net Hospital Maintains a Patient-Centered Revenue Cycle

by Jacqueline LaPointe

In the Hudson Valley is Montefiore St. Luke’s Cornwall Hospital. The non-profit, safety-net hospital serves more than 270,000 patients residing in the area and hospital leaders have made...

Hospital Claim Denials Up for Most, Driven by Prior Authorizations

by Jacqueline LaPointe

Hospitals and health systems are facing a growing volume of claim denials, with private plan prior authorization issues driving the recent increase, according to a new report from the American Hospital...

Most Physicians Prefer Single-Payer Option Over Medicare For All

by Jacqueline LaPointe

Providing affordable health insurance coverage is a top goal for physicians and most believe healthcare can achieve that through a single-payer option, a new survey reveals. The final installment of...

CMS to Expand Prior Authorizations for Certain Ambulance Transports

by Jacqueline LaPointe

CMS is expanding a program integrity payment model that saved Medicare $650 million by targeting inappropriate overuse of ambulance services using prior authorizations. In an announcement yesterday,...

Prior Authorization Burden Continues to Rise, Physicians Report

by Jacqueline LaPointe

Physicians are still expending a significant amount of time and resources on prior authorizations as the burden of the process continues to increase, according to a recent survey conducted by the...

CAQH CORE Approves 2-Day Limit for Prior Authorization Response

by Samantha McGrail

CAQH CORE recently voted on a new rule to set a two-day time limit to speed up the prior authorization process, according to a recent press release. Under the new rule, CAQH CORE participating...

Prior Authorization Costs Rise as Electronic Adoption Remains Low

by Jacqueline LaPointe

Prior authorization costs accounted for just two percent of overall medical industry spending on administrative transactions in 2019, but the process was the most costly, time-consuming transaction for...

Prior Authorizations, Quality Payment Program Burden Practices

by Jacqueline LaPointe

A vast majority of medical group practices experienced growing regulatory burden in the last year, with prior authorizations and Medicare’s Quality Payment Program topping their list of the most...

6 Challenges of End-to-End Automation for Prior Authorizations

by Jacqueline LaPointe

Only 12 percent of the 182 million medical sector prior authorization transactions were fully electronic in 2018, making prior authorizations one of the most manual transactions compared to other...

How Advocate Aurora Health Streamlined Prior Authorizations

by Jacqueline LaPointe

Prior authorizations used to be one of the greatest pain points for providers at Advocate Aurora Health. While most physicians recently surveyed by the American Medical Association (AMA) said they...

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