Editor's Note Republicans secured a 51-seat majority in the US Senate after victories in Ohio and West Virginia, promising a power shift that will see GOP leaders shaping decisions on pressing issues like drug pricing, public health agency reform, and rural healthcare. On November 6, STAT published an overview of…

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Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…

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Editor's Note A Medicare policy introduced in 2020, which requires prior authorization for certain procedures done at hospital outpatient departments (HOPDs), has not significantly reduced the volume of surgical procedures being done at these facilities, reports a study by Michigan Medicine, University of Michigan, published on October 9. The policy,…

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Editor's Note The American Medical Association (AMA) annual, nationwide prior authorization survey reveals that over 90% of physicians believe prior authorization negatively impacts patient clinical outcomes. “More telling,” AMA reported July 17, is the fact that 78% of physicians report that this process “sometimes or often” leads to patients abandoning…

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Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…

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Editor's Note The Centers for Medicare & Medicaid Services (CMS) has implemented a final rule reforming the prior authorization process, with the aim to reduce delays in patient care and boost electronic efficiency for physicians, the American Medical Association (AMA) News Wire reported January 23. The Department of Health and…

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In every OR, the complicated dance of surgical care coordination—the series of handoffs between stakeholders throughout the surgery lifecycle—is performed mainly in the background. Those stakeholders include physician offices, schedulers, preadmission testing, insurance verification, vendors, sterile processing, supply chain, anesthesia, and surgical staff. But what does it look like when…

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Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials.  According to the survey,…

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