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Results for "prior authorization"
1.
Highlights from 10 RISE National sessions: Regulatory updates, strategies to improve Star ratings, risk adjustment, payer/provider collaboration
2.
Regulatory update: LGBTQ clinics sue over HHS transgender discrimination rule; CMS calls for faster move to value-based care due to COVID-19;
3.
Medicaid news roundup: 11 more states receive Section 1134 waivers for COVID-19; CMS releases checklists to help states respond to outbreak
4.
Medicare Advantage news roundup: Insurers prep for surge of new members with end-stage renal disease; HHS files appeal to reinstate overpayment rule; Plans urged to waive prior authorization
5.
COVID-19’s impact on the 2021 and 2022 Star ratings
6.
Regulatory roundup: COVID-19 leads to expanded telehealth benefits, new CPT code; CMS unveils model to lower insulin out-of-pocket expenses; and more
7.
Coronavirus update: WHO declares COVID-19 a pandemic; CMS issues guidance for Medicare Advantage plans to waive cost-sharing for tests, treatments
8.
CMS releases Part 2 of the 2021 Medicare Advantage Advance Notice: 3 things you need to know
9.
HEDIS® 2020: How health plans can impact the opioid epidemic through preventive measures
10.
CMS Largely Finalizes Part D Provisions, Announces Significant Updates to MA Payment Rates, Risk Adjustment and Quality Provisions
11.
COVID-19 escalates opioid epidemic and other addictions, intensifies mental health issues
12.
Regulatory roundup: CMS aims to ease prior authorization burden; HHS proposes HIPAA rule changes; CDC director issues grim warning about COVID-19 deaths
13.
CMS finalizes interoperability and prior authorization rule
14.
Regulatory roundup: Calls to make Medicare reimbursement for telehealth services permanent; COVID relief package could bring major changes to the ACA; and more
15.
Regulatory roundup: HHS to spend $150M to support underserved communities with COVID-19 response; Medical associations protest CMS prior authorization requirements; and more
16.
MA news: Dual eligibles face fewer care disruptions; House bill aims to reform prior authorization requirements; Marketshare may grow via mergers and acquisitions; and more
17.
The latest trends in Medicare Advantage: What enrollment, Star ratings, and plan benefits look like in 2021
18.
HHS unveils interim rule aimed at putting an end to surprise medical bills for all consumers
19.
Regulatory roundup: ACOs generated billions in savings for Medicare; CMS urge MAOs to ease up on prior authorization requirements due to COVID-19; and more
20.
RISE West 2021: Highlights from day two of the conference
21.
Major insurers running billions of dollars behind on payments to hospitals and doctors
22.
MA in the news: More plans to offer non-medical supplemental benefits in 2022; Study finds industry provides $32.5B annually in additional benefits, lower out-of-pocket costs; and more
23.
Medicare FFS improper payments down $20 billion since 2014
24.
Regulatory roundup: CMS to reassess Part B premium after Alzheimer’s drug price cut; White House orders private insurers to cover at-home COVID tests; and more
25.
Regulatory roundup: Fed report suggests health plans fail to deliver on mental health parity; CMS to post nursing home staffing data to improve quality care; and more
26.
A health care crisis looms: Inovalon’s Dr. Paige Kilian on the need to integrate quality and risk programs, improve provider engagement, and reduce administrative burden
27.
OIG report on prior authorizations raises concerns about MA beneficiary access to medically necessary care
28.
Why so slow? Legislators take on insurers’ delays in approving prescribed treatments
29.
Regulatory update: AHA calls for Justice Department to create taskforce to investigate MA denials; Study finds 10K seniors got unnecessary surgeries during first year of COVID; and more
30.
Regulatory roundup: HHS: Providers must offer abortions in emergencies; Marketplace insurers denied nearly 1 in 5 in-network claims in 2020; and much more
31.
Regulatory roundup: CMS suspends prior authorization requirements for certain orthopedic devices; HHS paves way for emergency use authorization for monkey pox vaccine; and more
32.
MA moves closer to becoming predominant way seniors get their health coverage and care
33.
Medical coding creates barriers to care for transgender patients
34.
Medicare Advantage prior authorization bill passes House, heads to Senate
35.
CMS proposes rule to overhaul the prior authorization process: 5 things to know
36.
Regulatory roundup: Open enrollment has 5.5M enrollees so far; More employers offer Medicare Advantage to retirees; and more
37.
CMS releases the 2024 Medicare Advantage Proposed Rule: What it means for Star ratings, prior authorization, and marketing requirements
38.
Regulatory roundup: Medicare, Medicaid policies included in the $1.7T spending package; ACA marketplace enrollment outpaces previous years; and more
39.
CMS releases the 2024 Medicare Advantage and Part D Advance Notice: Proposed changes to Stars, MA risk adjustment
40.
Regulatory roundup: Biden vows to protect Medicare from budget cuts; MA plans denied 2M prior authorization requests in 2021; and more
41.
DOJ: False Claims Act settlements, judgments exceed $2B in 2022 and most involved health care fraud
42.
RISE National 2023 can’t-miss sessions: OIG reps to offer a deep dive into high-risk areas for MA plans
43.
Regulatory roundup: Lawmakers call on more MA reforms; CMS pushes to expand coverage for mobility devices; and more
44.
HHS rebuts claims that Advance Notice will lead to MA plan payment cuts
45.
Report: Big insurers offer luxury vacations, cash bonuses to brokers selling Medigap coverage
46.
Live from RISE National 2023: Highlights from Day One
47.
Warning from Inspector General: MA plans get ready for more OIG enforcement
48.
Feds move to rein in prior authorization, a system that harms and frustrates patients
49.
2024 Medicare Advantage Final Rule: 6 things you need to know
50.
How payer-provider collaboration can be improved with PINC AI™ Stanson technology
51.
Regulatory roundup: Prior authorization requirements increase with MA enrollment; Proposed work requirements could end Medicaid coverage for 1.7M people; and more
52.
Researchers: Urgent need for data Medicare Advantage quality of care, supplemental benefits
53.
Medicare Advantage in the hot seat: Senate panel probes health care denials and delays
54.
Regulatory roundup: Congress urges CMS to finalize prior authorization rules; MedPAC report to Congress recommends standardized benefits, payment reform in MA; and more
55.
OIG: Medicaid managed care enrollees may not receive access to medically necessary care
56.
White House proposes new rules for private health insurers to improve mental health benefits
57.
Insurers join AHA, AMA to protest conflicting proposed prior authorization standards
58.
CompliancePalooza 2023: Virtual event to cover regulatory changes, CMS audit prep, and new areas of scrutiny
59.
Medicare Advantage in 2023: 15 trends in enrollment, premiums, and supplemental benefits
60.
How payers and providers can simplify the prior authorization process with PINC AI™ Stanson technology
61.
Research roundup: Half of MA members leave plan after five years; HHS finds beneficiaries switching out of traditional Medicare drove MA growth; and more
62.
CMS projects MA plan premiums will remain stable in 2024
63.
Insurers often shortchange mental health care coverage, despite a federal law
64.
Tiny, rural hospitals feel the pinch as Medicare Advantage plans grow
65.
Catalyzing positive change in HCC coding and prior authorization
66.
2025 Medicare Advantage Proposed Rule calls for major changes to agent and broker pay, supplemental benefits, and the RADV appeal process
67.
Medicare Advantage increasingly popular with seniors—but not hospitals and doctors
68.
Senators call for improved MA data collection, reporting
69.
Woman petitions health insurer after company approves—then rejects—her infusions
70.
Regulatory roundup: Cigna reportedly near deal to sell MA business; Senators call on CMS for guidance on MA members’ access to long-term care facilities; and more
71.
Older Americans say they feel trapped in Medicare Advantage plans
72.
CMS finalizes rule to streamline the prior authorization process, estimates $15B savings over 10 years
73.
CMS seeks public input to improve transparency within Medicare Advantage
74.
Interoperability in 2024: 3 key updates for payers
75.
Regulatory roundup: CMS announces plans to expand audits in FAQ for 2024 MA final rule, proposes rule to bolster oversight of accrediting organizations, and more
76.
States target health insurers’ ‘prior authorization’ red tape
77.
‘Behind the times’: Washington tries to catch up with AI’s use in health care
78.
Regulatory roundup: CMS releases guidance for MA plans to report supplemental benefit data via EDS; OIG audit: MediGold received $3.7M in MA overpayments; and more
79.
Change Healthcare cyberattack fallout: Steps organizations can take to protect their systems
80.
CMS takes steps to address Change Healthcare cyberattack crisis, but AHA says efforts don’t go far enough
81.
Latest MA research examines quality bonus incentives, enrollment trends, and home health care benefits
82.
Live from RISE National 2024: Medicare Advantage compliance takes center stage in presentations from OIG, DOJ, and CMS
83.
8 quotes from RISE National 2024 that will make you think
84.
RISE National 2024: Compliance insights from the Inspector General
85.
2025 Medicare Advantage Final Rule is out: 10 things to know about the changes