Cost & Utilization Management
Expert articles and analysis related to cost & utilization management.
AI Summary — Last 24 Hours
Federal scrutiny of prior authorization intensified as a House appropriations panel moved to block CMS’ Medicare AI prior authorization pilot, while HHS OIG found Medicare Advantage plans overturned nearly all appealed skilled nursing facility denials—raising questions about whether initial denials are being used to manage utilization at the expense of timely post-acute care access (Healthcare Dive; [HHS OIG](https://news.google.com/rss/articles/CBMisAJBVV95cUxNd0J6dk9BY3ZHNjRwTDh0NTFjWUhSVEVveDRsMnpaSVZRSWZOMjI3OGppQWJ3OVE5ZTJWeE5WUFR1SnhwaHBVRC15QUdFcU1BbHpOa1lpM0xVTjBZTEVlQWVhd29XekZkSzRLZWJQcWRqYlpLWTJ0c2xJLWVVWTdmUFJZME9id3VaeHRzVTlWM0doZHdkb2prMDVTX3JFbEh6UXQtTUc1R2tUUWlYSlZZcFIycGZtWFdDY1VlUHYzdF94SDF0RGZ2
Related Articles
Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials - Office of Inspector General (.gov)
Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials Office of Inspector General ...
Even with Health Insurance, Half of Working-Age People in the U.S. Can’t Afford Healthcare (and a PS on Retiree Health Costs)
How a CMS Proposed Rule Would Bridge the Divide Between EHRs and Payers on Electronic Prior Authorization
The following is a guest article by Tyler Wince, VP of Product & Technology for Specialty Solutions at DrFirst. This article is the next in the Healthcare Regulatory Talk series. Prior authorization ...
House committee takes step toward blocking Medicare AI prior authorization pilot
It’s another sign of lawmakers’ concern about the pilot, which has been lambasted for delaying care to seniors.
Americans mostly blame insurers for rising healthcare costs, survey finds
AHIP argued the survey, which was commissioned by a pro-hospital advocacy group, is a blatant attempt by hospitals to deflect the blame for ever-higher spending.
Nearly Half of Working-Age Adults Had Difficulties Affording Health Care in 2025
Nearly Half of Working-Age Adults Had Difficulties Affording Health Care in 2025 Urban Institute
STAT+: As the U.S. looks on, European countries feel growing pressure on drug prices
In Europe, two divergent paths are emerging as countries grapple with what to do about drug prices, affecting both pharma and patients — and testing the influence of the U.S.
The 5 Areas Where Dr. Oz Says CMS Can Make Healthcare More Affordable
CMS Administrator Dr. Mehmet Oz outlined the agency’s strategy for making healthcare more affordable during a Tuesday address at the HFMA Annual Conference, touching on everything from Medicare fraud ...
Preparing Health Plans for the 2027 CMS Prior Authorization Rule
Preparing Health Plans for the 2027 CMS Prior Authorization Rule AHIP
STAT+: Private Medicare plans erect barriers to rehab care in pursuit of profit, federal investigators find
Federal investigation finds Medicare Advantage insurers block rehab care for older adults, only to reverse denials on appeal.