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 ...

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 ...

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 ...

In January, the federal Centers for Medicare & Medicaid Services will launch the Wasteful and Inappropriate Services ...

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 ...

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 ...

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 ...

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 ...

Like millions of doctors, I knew the best care and treatment to prescribe for my patients. As a former ER physician, I built trust with my patients and was there for them when they received bad news.