Tag: Electronic Prior Authorization

failing on prior auth reform

Health Insurance Industry Is Failing on Prior Authorization Reform

In theory, prior authorization (PA) exists to ensure that healthcare services are medically necessary and cost-effective. But in practice, it has become a bureaucratic roadblock causing treatment delays, administrative overload, and provider burnout. Despite increasing pressure from physicians, hospitals, patient advocacy groups, and even bipartisan lawmakers, the health insurance industry failing on prior authorization reform […]
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Electronic Prior Authorization

Electronic Prior Authorization: Improving Speed and Efficiency for Physicians

In the intricate dance of healthcare administration, few processes have historically caused as much friction as prior authorization. The traditional, often manual, methods of obtaining approval for medical services and medications have long been a source of frustration for both physicians and patients. Lengthy wait times, administrative burdens, and potential delays in necessary care have […]
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Prior Authorization reforms

CMS Prior Authorization Reforms: A Step Forward, But More Needed

The updated CMS regulations on prior authorization have been lauded as a significant step toward reducing administrative burdens for physicians. However, critics argue that the changes fall short of addressing the broader issues. Accelerating Prior Authorization and Enhancing Transparency Issued in January, these regulations mandate federally regulated health plans to enhance electronic health information exchange […]
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CMS released the CMS Interoperability and Prior Authorization final rule

CMS Interoperability and Prior Authorization Final Rule: On January 17, 2024, the Centers for Medicare and Medicaid Services (CMS) published the CMS Interoperability and Prior Authorization final rule (CMS-0057-F). The final rule aims to reduce the burden on patients, providers, and payers by consolidating the authorization process and moving the industry electronically. Affected payers must […]
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CMS Unveils Final Rule to Streamline Prior Authorization Processes

CMS Unveils Final Rule to Streamline Prior Authorization Processes

Affected payers have to be sent earlier authorization choices inside 72 hours for pressing demands and seven days for standard requests. Under a last run the show discharged nowadays, affected payers will be required to send earlier authorization choices inside 72 hours for critical demands and seven calendar days for standard requests. The Centers for […]
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