In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

Strengthen your financial backup. Even with Medicare coverage, unexpected out-of-pocket expenses can pop up. Earn as much as ...

When stakeholders think about prior authorization in the Medicare program, they usually focus on its use in Medicare Advantage (MA), and not how it is used in traditional Medicare. In fact, a few ...

Prior authorization is a process that involves contacting a person’s Medicare provider to request coverage for a medical service, drug, or piece of equipment. If a person has Original Medicare (parts ...

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 ...

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

When you join a Medicare Advantage plan, your care sometimes requires an extra step before treatment begins. This process is called prior authorization, and it helps your insurance plan confirm that a ...

New analysis further supports the need for stronger policies to streamline the administrative process. More than two million prior authorization requests, accounting for six percent of the 35 million ...

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 ...

Prior authorization is the process through which a doctor seeks approval from a person’s health insurance plan before ordering a specific medication or medical service. Original Medicare (parts A and ...