Insurance & Managed Care
Expert articles and analysis related to insurance & managed care.
AI Summary — Last 7 Days
In the past week, bipartisan pressure on CMS has intensified to address Medicare Advantage overpayments, with lawmakers urging the agency to collaborate with Congress on stronger oversight and policy remedies targeting upcoding and payment integrity concerns [Merkley, Cassidy, Smith, Marshall to CMS: Work with Congress]. Simultaneously, provider-payer friction is escalating in
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How AI rewired prior authorization at Renown Health
How AI rewired prior authorization at Renown Health  Advisory Board
West Virginia Changes Prior Authorization Law After Man's Treatment Delay and Death
How prior authorization and step therapy harm pain management
Imagine a 54-year-old construction worker named Mike living with debilitating chronic lower back pain after years on the job. His doctor recommends a targeted epidural steroid injection and a short co...
After A Death Following Insurance Denials, West Virginia Tackles Prior Authorization
After A Death Following Insurance Denials, West Virginia Tackles Prior Authorization  HealthLeaders Media
After Man’s Death Following Insurance Denials, West Virginia Tackles Prior Authorization
After Eric Tennant died, his widow vowed to speak out against West Virginia’s Public Employees Insurance Agency, which had denied cancer treatment recommended by Tennant’s doctor. Her efforts paid off...
The payer battles coming to outpatient surgery
As outpatient surgery continues its rapid migration from hospitals, a tension is emerging: the same payers pushing care into lower-cost settings are also making it harder to deliver it. From prior aut...
Tech nonprofit sues CMS over Medicare AI prior authorization pilot
The Electronic Frontier Foundation is seeking more information on the government’s agreements with participating vendors, along with records related to any evaluations on accuracy, bias or hallucinati...
Prior Authorization Transparency and the Debate Over Vertical Integration with Jakob Emerson
Prior Authorization Transparency and the Debate Over Vertical Integration with Jakob Emerson  Becker's Hospital Review
The hidden cost of denials: How process failures erode provider trust
The hidden cost of denials: How process failures erode provider trust  Advisory Board