News & Analysis as of

Healthcare Prior Authorization Health Care Providers

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

Stevens & Lee on

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

Phelps Dunbar

Medicare’s New AI Payment Review Model: What Providers Need to Know

Phelps Dunbar on

CMS announced the rollout of the WISeR (Wasteful and Inappropriate Service Reduction) model in June. It aims to use technologies like artificial intelligence (AI) to “ensure timely and appropriate Medicare payment for select...more

McDermott+

Three key takeaways from the CMS Innovation Center’s new WISeR Model

McDermott+ on

The last week of June was a busy one when it comes to news about prior authorization – a major tool used by health plans and the federal government to manage healthcare utilization. The week started with a commitment from...more

Stotler Hayes Group, LLC

Medicare Advantage Plans Onerous Prior Authorizations Requirements & Negative Impacts on Skilled Nursing Facilities

Traditional Medicare (Parts A and B) and Medicare Advantage (Part C, including additional vision, dental, and hearing benefits) plans aim to provide comprehensive medical benefits to American Seniors and adults with...more

McCarter & English, LLP

New Jersey Statutory Update Part II

Below is Part II of our New Jersey Statutory update. As you can see from the below, several statutes were passed imposing requirements on health insurance payers, including new requirements for prior authorization request and...more

Epstein Becker & Green

Advancing Interoperability and Improving Prior Authorization: No One Said It Would Be Easy!

The Centers for Medicare & Medicaid Services (CMS) recently published the CMS Advancing Interoperability and Improving Prior Authorization Processes Final Rule (“PA Final Rule”) in the Federal Register....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

Sheppard Mullin Richter & Hampton LLP

CMS Finalizes its Proposal to Advance Interoperability and Improve Prior Authorization Processes

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and...more

Holland & Hart - Health Law Blog

2019 New Mexico Legislative Update: What All Healthcare Providers Should Know

In 2019, the Legislature enacted several bills affecting healthcare practitioners in New Mexico. Although some bills have a general applicability to health care providers, others address more specific medical practices....more

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