Six states are part of a pilot program by CMS to reduce “waste, fraud and abuse.” ...

Prior authorization forces doctors to spend 13 hours a week fighting insurers. New federal rules are changing that. Here's what you need to know.

Prior authorization is the process by which your doctor must request approval from your Medicare plan before they can order a particular medication or medical service. Generally, Original Medicare ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

UnitedHealth Group and CVS Health have standardized data and submission rules for more than half of their prior ...

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 ...

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 ...

Whether you’re filling a prescription or scheduling a procedure, chances are you’ve been asked whether you have prior authorization. By learning to navigate prior authorization and what steps to take ...

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 ...