Administrative costs are estimated to make up between 20 and 34 percent of US health care expenditures, roughly 1–4 percent of GDP. Academic and policy discussions generally characterize these costs ...

Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care. The Center for Medicare ...

The CMS will soon make it more difficult for providers in six states to get reimbursed in Medicare for certain medical procedures it has deemed “low value,” but some stakeholders worry it could lead ...

Medicare enrollees in Washington and five other states could soon need preapproval for certain medical services — a familiar hurdle for commercial insurance plans, including Medicare Advantage, but ...

Medicare providers participating in and payers offering Part C and Part D plans are facing increasing pressure to move into the 21st century, and the government is taking decisive steps to ensure this ...

Surveyed medical groups reveal burdens have increased in the past 12 months, resulting in delays or denials for necessary care. Despite scrutiny of prior authorization practices in Medicare Advantage ...

Traditional Medicare in six states will soon feel more like privatized Medicare Advantage, using prior authorizations to ...

Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many older adults choose original Medicare ...

(L-R) White House AI and Crypto Czar David Sacks, Secretary of Health and Human Services Robert F. Kennedy Jr., President Donald Trump, Centers for Medicare and Medicaid Services Administrator Mehmet ...

The American Hospital Association and American Medical Association are among the groups applauding Medicare Advantage prior authorization reforms included in a final rule issued by CMS April 5. Editor ...