Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. My 90-year-old uncle, a retired county employee, has had a ...

Medicare providers participating in and payers offering Part C and Part D plans are facing increasing pressure to move into the 21st century, and the government is taking decisive steps to ensure this ...

The AI-powered prior auth requirements under the CMS' Wasteful and Inappropriate Service Reduction model would increase ...

Medicare has selected the technology vendors who'll run its prior authorization pilot in New Jersey, Ohio, Oklahoma, Texas, ...

Lawmakers argue the CMS innovation center pilot, which will implement AI-backed prior authorization for some services in six ...

Medicare Advantage prior authorization (PA) is the process you go through to get certain services and drugs approved before ...

Prior authorization is a process that involves contacting a person’s Medicare provider to request coverage for a medical service, drug, or piece of equipment. If a person has Original Medicare (parts ...

The American Hospital Association and American Medical Association are among the groups applauding Medicare Advantage prior authorization reforms included in a final rule issued by CMS April 5. Editor ...

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 ...

Step therapy is when Medicare Part D plans ask beneficiaries to try a more affordable drug before approving higher-cost prescriptions. In Medicare, Part D covers general prescription drugs, whereas ...

Administrative costs are estimated to make up between 20 and 34 percent of US health care expenditures, roughly 1–4 percent of GDP. Academic and policy discussions generally characterize these costs ...