Health Care Dive

MAY 27, 2022

If Congress grants regulators the expanded authority, actors could be protected from steep fines for data-sharing practices the HHS previously said were acceptable under complex information blocking regulations.

Regulations 187

Regulations 187

Fierce Healthcare

MAY 8, 2023

SCOTUS wants to revisit executive agency authority. What does that mean for healthcare? dmuoio Mon, 05/08/2023 - 19:57

Healthcare 167

Healthcare 167

Fierce Healthcare

APRIL 18, 2024

Medication management platform DrFirst this week closed its acquisition of Myndshft Technologies, an AI-enabled benefits and prior authorization verification platform. |

Hospitals 130

Hospitals 130

Home Health Care

APRIL 3, 2024

Yet another payer organization is removing certain prior authorization requirements for home health care services. Point32Health – the parent company of Harvard Pilgrim Health Care and Tufts Health Plan – announced Wednesday that it is removing prior authorization requirements for the first 30 days of home health care beginning on April 12.

Rehabilitation 68

Rehabilitation Home Care Quality of Care Hospitals 68

Health Care Dive

AUGUST 24, 2023

The insurer also plans to nix another 500 codes for its Medicare Advantage plans before the end of this year.

Medicare 246

Medicare 246

Fierce Healthcare

MAY 26, 2023

Industry Voices—How UHC's new prior authorization policy for colonoscopies could make patients wait pminemyer Fri, 05/26/2023 - 10:45

144

144

HIT Consultant

JUNE 22, 2023

But there are still many potential AI applications that can disrupt the industry and one stands out: expediting the prior authorization process. The current state of prior authorization The prior authorization process has many inefficiencies that can lead to negative patient outcomes and frustration among physicians.

Prevention 96

Prevention Medicare Healthcare Hospitals 96

NASHP

OCTOBER 2, 2023

To address the housing needs of Medicaid beneficiaries, states can leverage a variety of Medicaid authorities, including through the state plan, a variety of waivers, and managed care arrangements, to cover housing-related services under state Medicaid programs.

Medicaid 72

Medicaid Performance improvement Integration Nursing 72

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. It is time for intelligent utilization management, beginning with prior authorization.

Medicaid 97

Medicaid Medicare Quality of Care Patient Experience 97

Home Health Care

NOVEMBER 7, 2023

Blue Cross Blue Shield of Massachusetts is getting rid of one of the biggest pain points for home health providers: prior authorization. The change will eliminate more than 14,000 authorizations, according to the company. Prior authorization requirements will be dropped for home health care in commercial plans by Jan.

Physical Therapy 95

Physical Therapy Patient Safety Hospitals Medicare 95

Health Care Dive

FEBRUARY 27, 2023

Lucira filed for bankruptcy protection last week, saying the “protracted” authorization process caused it to miss out on test sales in the latest flu season.

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130

Healthcare ECONOMIST

OCTOBER 25, 2022

Prior authorization policies may save money for payers, but they impose significant costs on patients and providers. A JAMA Viewpoint by Anderson, Darden and Jain (2022) examines various approaches for improving prior authorization in Medicare Advantage. CMS should audit the denials of plans with high-denial rates.

Medicare 98

Medicare Primary Care 98

Health Care Dive

JUNE 30, 2022

The payer said its decision came after analyzing real-time data when the requirement was in place and that it will continue to perform retrospective reviews.

246

246

HIT Consultant

APRIL 14, 2023

Addressing Treatment Delays in Cancer Care Unfortunately, health insurance plans often limit cancer patients’ access to recommended biomarker testing, impose burdensome prior authorization protocols, or require unaffordable cost-sharing, which can prevent or delay cancer patients’ access to optimal treatments.

Regulations 96

Regulations Doctors Prevention 96

Health Care Dive

OCTOBER 17, 2022

Paperwork-intensive prior-authorization processes have become an impediment to timely healthcare delivery.

Healthcare 276

Healthcare 276

HIT Consultant

JANUARY 26, 2023

House of Representatives passed a bill intended to accelerate patient access to care by streamlining prior authorization (PA) processes. Indeed, digitizing prior authorization processes does accelerate the submission of requests and the ensuing clinical review process.

Quality of Care 52

Quality of Care Medicare Patient Experience Medicaid 52

Home Health Care

OCTOBER 10, 2022

Home health providers could potentially see a speedier prior authorization process thanks to legislation moving through Washington, D.C. Cohere Health is a digital health company focused on transforming prior authorization. Traditional prior authorization has not always been the most seamless process.

Medicare 73

Medicare Patient Experience Medicaid Healthcare 73

Bill Of Health

AUGUST 22, 2022

In addition to these waivers, certain payers and insurance plans have implemented prior authorization (PA) requirements that require a prescriber must submit a PA to get advanced approval by the payer to signify that the payer agrees to cover the medication. This strategy may be used by payers as a mechanism to discourage claims.

Medicaid 98

Medicaid Pharmaceuticals Regulations 98

Health Care Dive

JUNE 17, 2022

The much-anticipated decision follows two days after a panel of independent experts unanimously recommended expanding the shots’ use. A CDC panel is meeting Friday and Saturday to develop specific recommendations.

130

130

Etactics

FEBRUARY 15, 2022

In 2017, an American Medical Association (AMA) found that healthcare facilities spend two days every week working through prior authorization (PA) requirements on average. Insurances continue to expand their prior authorization requirements , making the process even more labor some. How Does a Prior Authorization Denial Happen?

Healthcare 52

Healthcare Doctors Hospitals 52

HIT Consultant

OCTOBER 24, 2022

What You Should Know: – Health insurer Humana has expanded its partnership with Cohere Health to streamline the prior authorization process for cardiovascular care and surgical specialties. By ensuring requests are reviewed expeditiously, the platform helps providers and patients avoid the complications that can arise from delayed care.

Primary Care 52

Primary Care Quality of Care 52

Fierce Healthcare

APRIL 24, 2024

The California Hospital Association (CHA) has filed suit against Anthem Blue Cross, alleging the insurer's authorization protocols for post-acute care leave patients stuck with long waits for disch | The California Hospital Association has filed suit against Anthem Blue Cross, alleging the insurer's authorization protocols for post-acute (..)

Hospitals 130

Hospitals 130

Health Care Dive

NOVEMBER 10, 2021

Agency advisers had opposed a broad booster dose clearance in September, leading the FDA to limit use to older adults and those at high risk of COVID-19.

130

130

HIT Consultant

FEBRUARY 1, 2024

Cohere Health, a provider of AI-driven clinical intelligence and prior authorization automation solutions raises $50M in Series C funding.

52

52

Fierce Healthcare

JANUARY 25, 2024

CMS initiated a request for information period Thursday to receive data on all aspects of the Medicare Advantage program including prior authorizations, value-based care and vertical integration.

Medicare 326

Medicare Medicaid Integration 326

Fierce Healthcare

DECEMBER 14, 2023

A new price comparison study finds over 50% higher facility fees for commercially insured colonoscopies performed in hospitals rather than ambulatory surgery centers (ASCs), suggesting that “money | The analysis of commercial payers' price transparency data shows that “money has apparently been left on the table” for employers and consumers, the (..)

Hospitals 346

Hospitals 346

Healthcare It News

APRIL 5, 2024

Cohere Health advances 'last mile' with AI integration in Epic To advance clinical intelligence and speed up prior authorization requests, a new AI-driven prior authorization integration in Epic will enable providers nationwide to submit directly in their EHR workflows, Cohere Health announced on April 3.

Integration 213

Integration Medicaid Hospitals Prevention 213

Fierce Healthcare

FEBRUARY 1, 2024

A recommendation on the 2024 Measures Under Consideration list, brought forward by the Federation of American Hospitals (FAH), would add a quality measure in the Medicare Advantage (MA) star rating | The Federation of American Hospitals is pushing CMS for the inclusion of a star ratings quality measure that shows how often insurers overturn or uphold (..)

Hospitals 318

Hospitals Medicare 318

Fierce Healthcare

FEBRUARY 21, 2024

Medicare Advantage (MA) beneficiaries are more likely than traditional Medicare enrollees to experience delays in care while they wait for prior authorization approval, but MA members are likely to | Medicare Advantage and traditional Medicare enrollees experience similar access to services and similar challenges, a report from the Commonwealth Fund (..)

Medicare 274

Medicare 274

Fierce Healthcare

DECEMBER 11, 2023

Floreo, maker of virtaul reality (VR) behavioral therapy content, has received the Food and Drug Administration’s breakthrough device designation. | Floreo says it seeks full market authorization to further recognize its effectiveness and to open up reimbursement pathways for its tech to reach more families.

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318

Fierce Healthcare

OCTOBER 31, 2023

The company sold its clearinghouse and patient access business units to Waystar and its prior authorization business unit to Humata Health. Healthcare startup Olive saw a meteoric rise in 2020 and 2021, spurred by the digital health funding boom and the need for automation during the COVID-19 pandemic. |

Healthcare 341

Healthcare 341

Triage Health Law

FEBRUARY 6, 2023

Further, the Commission reiterated that when the enrollee is no longer at that number, or never provided it in the first place, “federal and state agencies may nevertheless use autodialers to call or send the text to reach” them, “despite the lack of prior express consent.”

Medicaid 59

Medicaid 59

Fierce Healthcare

JUNE 12, 2023

Prior authorization has been a flashpoint for providers, and, while insurers have taken steps to ease these utilization management protocols, they still play a key role as the industry shifts to va | Prior authorization has been a flashpoint for providers, and, while insurers have taken steps to ease these utilization management protocols, they still (..)

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273

Fierce Healthcare

NOVEMBER 3, 2023

The time-sensitive GI procedures that UHC is targeting with prior authorization are critical in helping to detect, treat, and monitor a range of diseases that impact millions of Americans. Insurance policies are notoriously known for red tape and processes that burden both doctors and patients. |

Doctors 290

Doctors 290

Briggs Healthcare

FEBRUARY 17, 2022

February 11, 2022…CDC updated Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the U.S. Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. There is a huge amount of information and resources on this landing page, including all previous updates (24) in the past year.

Healthcare 52

Healthcare 52

Healthcare It News

DECEMBER 15, 2023

He said that new AI-driven features in athenaOne are already helping to improve healthcare efficiency and address clinician burnout by cutting administrative tasks, such as the proactive identification of missing prior authorization information achieving an 18% reduction in task completion across EHR users.

Patient Experience 290

Patient Experience Healthcare Nursing Prevention 290

Healthcare It News

APRIL 18, 2024

"Disclosures of PHI to tracking technology vendors for marketing purposes, without individuals’ HIPAA-compliant authorizations, would constitute impermissible disclosures," OCR clarified in the revised guidance. The most common categories of disclosed third-party recipients were: Service providers – 50 policies or 70.4%

Hospitals 231

Hospitals Healthcare 231