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Health Care Providers › Department of Health and Human Services (HHS) › Prior Authorization

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

King & Spalding

GAO Publishes Findings Regarding Prior Authorization of Behavioral Health Services

King & Spalding on

Last week, the Government Accountability Office (GAO) published a report determining that there is a nontrivial risk that prior authorization requirements, together with internal coverage criteria, may undermine the Medicare...more

Holland & Knight LLP

Regulation of AI in Healthcare Utilization Management and Prior Authorization Increases

Holland & Knight LLP on

Over the past two years, federal and state government agencies have moved to regulate the deployment of artificial intelligence (AI) in the healthcare setting, including in the utilization management (UM) and prior...more

BakerHostetler

The Long-Awaited Part 2 Modifications Are Finalized with New Obligations for Part 2 Providers and Less Friction for Sharing...

BakerHostetler on

On February 8, 2024, the U.S. Department of Health & Human Services (HHS) released a final rule modifying 42 CFR Part 2 (Part 2) provisions regarding the confidentiality of Substance Use Disorder (SUD) Patient Records. The...more

McDermott+

Prior Authorization in Traditional Medicare: Yes, It Exists

McDermott+ on

When stakeholders think about prior authorization in the Medicare program, they usually focus on its use in Medicare Advantage (MA), and not how it is used in traditional Medicare. In fact, a few weeks ago, the Centers for...more

Health Care Compliance Association (HCCA)

Dramatic Portrayal of Care During Early COVID-19 Costs Hospital $80K; OCR: No Prior Authorization

Health Care Compliance Association (HCCA) on

Report on Patient Privacy 23, no. 12 (December, 2023) Spring 2020 was a terrifying period in the annals of COVID-19, and New York was at the epicenter. COVID-19 cases, and deaths, already the highest in the nation, were...more

Baker Donelson

Physicians, Think Before You Yelp??

Baker Donelson on

Health care providers should take heed of the $10,000 settlement announced on October 2, 2019 between the U.S. Department of Health and Human Service (HHS) Office for Civil Rights (OCR) and a small dental practice based on...more

BakerHostetler

Capitol Hill Healthcare Update

BakerHostetler on

Below is this week’s “Capitol Hill Healthcare Update,” which is posted on Mondays when Congress is in session....more

K&L Gates LLP

K&L Gates Triage: Opioid Epidemic: Recent HIPAA Guidance – What Does It Mean?

K&L Gates LLP on

In the second episode of our series on the national opioid crisis, Gina Bertolini discusses the overlay of recent guidance concerning privacy laws such as the Health Insurance Portability and Accountability Act (HIPAA) and...more

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