CMS has issued a final rule to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that are often subject to unnecessary use.

Comments are due in less than a month on the Centers for Medicare & Medicaid Services (“CMS”) proposals to make significant structural reforms to Medicare’s Competitive Bidding Program (“CBP”) for ...

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

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.

Medicare enrollees in Washington and five other states could soon need preapproval for certain medical services — a familiar hurdle for commercial insurance plans, including Medicare Advantage, but ...

NEW YORK, June 17, 2024 /PRNewswire/ -- Parachute Health, the platform empowering simple DME and HME ordering, announces the launch of its groundbreaking collaboration with two of the largest ...

Under a final rule released today, impacted payers will be required to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. The Centers ...

Medicare Advantage plans say it reduces waste and inappropriate care. Critics say it often restricts coverage unnecessarily. By Paula Span Slowly but steadily, Marlene Nathanson was recovering. She ...

Highmark was among more than 50 health insurers who pledged Monday to speed up and slim down prior authorization, the process through which patients and their doctors must seek insurance approval for ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...