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Posts tagged with "Prior Authorization"

CMS Rules

CMS Expands Medicare Ambulance Model Nationwide

The new model now requires providers to get prior authorization (PA) before scheduling a non-emergent ambulance transport for a patient and pays ambulance services for taking patients to non-hospital facilities. A ride in an ambulance can cost between hundreds and thousands of dollars depending on locations, services and the...
National News

Fighting to Simplify Prior Authorization - CMS Targets Process Improvements in 2020

During a speech at the American Medical Association's National Advocacy Conference this month, CMS Administrator Seema Verma characterized prior authorization (PA) as "indefensible" and a "longstanding problem" in healthcare. Recent analysis shows alarming inefficiencies. This year, our efforts around innovation and reducing...
Arizona News

Members Only November Newsletter

The Hertel Report is only available to members. Click Here to Access. ...
National News

AMA Sets New Policy for Medicare & Medicaid Prior Authorization

According to the American Medical Association the words patients and physicians use to describe the current prior authorization process: Time-consuming, tedious and horrendous. During its annual meeting of delegates, The American Medical Association announced it wants government officials to carefully consider evidence that prior...
Two States Examine Aetna's Prior Authorization Practices National News

Two States Examine Aetna's Prior Authorization Practices

Attention focused after a former Aetna medical director admitted he never reviewed patient medical records when deciding whether to authorize treatment. California Insurance Commissioner Dave Jones confirmed he is launching an investigation into Aetna's processes in denying claims and requests for prior authorization for care, as...
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