In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

The American Hospital Association (AHA) and Better Medicare Alliance (BMA) both support the agency's effort to improve Medicare Advantage (MA). In an attempt to reform MA, CMS released a proposed rule ...

The Biden administration released a proposal which, if finalized, would mandate Medicare Advantage (MA), Medicaid managed care, Affordable Care Act (ACA) plans and state Medicaid agencies implement ...

The Centers for Medicare and Medicaid Services finalized the CMS Interoperability and Prior Authorization Rule on Wednesday. CMS said the rule will improve the prior authorization process and save ...

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. Over the last several years, prior authorization has become a ...

On Dec. 15, CMS will launch a five-year prior authorization demonstration for certain ASC services in California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York ...

U.S. physicians are calling on the federal government to take a broader approach in reducing the administrative burdens of prior authorization. In a letter to CMS sent Sept. 20, the American Medical ...

New Medicare prior authorization requirements will take effect for certain hospital outpatient department services July 1, according to Bricker & Eckler’s Shannon DeBra. 1. Blepharoplasty, botulinum ...

As part of its ongoing mission to modernize and improve the interoperability of the health care system, on January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.