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4 states tackling prior authorization
From repealing existing prior authorization requirements to adding new ones, here are four states tackling the prior authorization system this year. -
Is payer behavior taking away autonomy? This physician says yes
Physicians are facing rising prior authorization requirements and increasing denials, and some leaders say it is taking away their ability to make decisions. -
Payers cutting prior authorizations: 3 major moves to know
Three major payers have cut prior authorization requirements in August: -
3 Stark law updates affecting ASCs
Here are three Stark law updates that may affect ASCs: -
5 largest payers by market share
UnitedHealthcare is the largest insurer in the U.S. by market share, according to a July 2023 report from Value Penguin. -
The new prior authorization rules going into effect Sept. 1
On Sept. 1, UnitedHealthcare will begin its two-phased approach to eliminating prior authorization requirements. -
Cigna in the headlines: 9 updates in 60 days
Cigna, the fourth-largest insurer in the U.S. by membership, has received accolades — and scrutiny — in the last two months. -
3 most used medications on Medicare price negotiation list
The Biden administration has announced the first 10 medications that will be subject to price negotiations with Medicare under the Inflation Reduction Act. -
1st 10 drugs subject to payer negotiations under controversial Inflation Reduction Act
The Biden administration has revealed the first 10 medications that will be subject to price negotiations between manufacturers and Medicare under the Inflation Reduction Act, according to an Aug. 29 report from CNBC. -
AHA issues letter of support for 'gold card' legislation
The American Hospital Association, which represents 5,000 member hospitals, 270,000 affiliated physicians and 2 million nurses and caregivers, has authored a letter in support of proposed House Resolution 4968, the GOLD Card Act of 2023. -
Inside CMS' 2024 proposed pay schedule: 5 things to know
CMS has proposed a new Medicare physician payment schedule for 2024, addressing topics from anesthesia conversion rates to merit-based payment systems. -
5 largest health insurance companies by membership
UnitedHealthcare is the largest insurer in the U.S., according to a July 2023 report from Value Penguin. -
Florida physician pleads guilty to antitrust conspiracy that limited cancer options
Oncologist William Harwin, MD, former president and managing partner of Fort Myers-based Florida Cancer Specialists & Research Institute, has pleaded guilty in a conspiracy to allocate oncology treatments for cancer patients. -
Cigna Healthcare cuts 25% of prior authorization requirements
Cigna Healthcare is removing nearly 25 percent of medical services from prior authorization requirements, cutting more than 600 codes. -
Insurer-health system breakups: 3 cases to know
Here are three health system and payers splits since May: -
California legislature takes action to eliminate prior authorization
The California legislature is considering a bill that would prohibit prior authorizations for any healthcare service if the plan or insurer approved or would have approved not less than 90 percent of the prior authorization requests a provider submitted in the most recent completed one-year contracted period. -
Physicians could be in financial danger with this Stark law change
Physician groups who provide certain medical equipment, devices and supplies to their Medicare patients could be in violation of Stark law following the end of the COVID-19 public health emergency, attorneys from law firm Epstein Becker & Green wrote in an Aug. 14 JDSupra article. -
Commonwealth Health's physician group can't enforce noncompete law on former surgeon
A judge has ruled that Commonwealth Health's physician group, Commonwealth Physician Network, cannot prevent its former surgeon from working locally for Geisinger, The Times-Tribune reported Aug 21. -
UHC Texas adds 4 medications to Medicaid prior authorization list
Beginning Sept. 17, UnitedHealthcare Texas will begin requiring prior authorization for four medications based on new state guidelines for Texas' Medicaid program. -
US representative launches investigation into Medicaid prior authorization denials
Rep. Frank Pallone Jr., a Democrat from New Jersey, has announced an inquiry into the high rate of prior authorization denials by Medicaid managed care plans.
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