Prior Authorization, Physicians, Centers for Medicare & Medicaid Services (CMS)

GAO Publishes Findings Regarding Prior Authorization of Behavioral Health Services

King & Spalding on 6/9/2025

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

CMS Issues Final Rule Impacting Prior Authorization Process

Cozen O'Connor on 1/24/2024

Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

UnitedHealthcare’s Changing Approach to Prior Authorizations

Cozen O'Connor on 7/14/2023

Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and regulators, to name a few. The prior-authorization process requires a health...more

CMS Rules: Direct Supervision Is Gone, Prior Auth Is Here; Documentation Fix Has Limits

Health Care Compliance Association (HCCA) on 11/14/2019

Report on Medicare Compliance 28, no. 40 (November 11, 2019) - CMS has given the green light to prior authorization for five types of procedures in an attempt to control “unnecessary increases” in these procedures as part...more

CMS Seeks Additional Ideas for Reducing Administrative Burdens in Health Care

Baker Donelson on 6/21/2019

The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) focused once again on reducing the administrative burden for physicians by reviewing and revising regulations. The RFI, published...more

Prior Authorization › Physicians › Centers for Medicare & Medicaid Services (CMS)

GAO Publishes Findings Regarding Prior Authorization of Behavioral Health Services

CMS Issues Final Rule Impacting Prior Authorization Process

UnitedHealthcare’s Changing Approach to Prior Authorizations

CMS Rules: Direct Supervision Is Gone, Prior Auth Is Here; Documentation Fix Has Limits

CMS Seeks Additional Ideas for Reducing Administrative Burdens in Health Care

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