Payer Coverage Management
Expert articles and analysis related to payer coverage management.
AI Summary — Last 7 Days
Coverage management pressure is intensifying around Medicare Advantage as hospitals and policymakers push for statutory prior authorization and utilization-management reforms, with AHA backing the House Medicare Advantage Improvement Act while payers warn that MA margin, coding, and medical-cost pressures make the current model hard to sustain. At the same time, CMS under the Trump administration is signaling a more active prior authorization agenda—including Dr. Mehmet Oz’s comments on home health prior auth—creating a sharper tension for VBC stakeholders between reducing inappropriate denials and preserving plan tools for managing total cost of care and post-acute utilization (AHA on MA reform; [Dr. Oz
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