The Office of Inspector General (OIG) recently released an audit report on prior authorization and payment denials by Medicare Advantage Organizations (MAO). The result raised OIG concerns about certain MAO denial practices impacting beneficiary access to medically necessary care.Read More »
While some people choose to manage denials by using “zone defense,” others opt for a targeted approach. “My denials team works by payer,” says Frank Cantrell, CHRI, corporate director of revenue integrity at Penn Highlands Healthcare in DuBois, Pennsylvania. “They know their...Read More »
CMS released a proposed rule on December 6 to promote transparency, efficiency, and automation in prior authorization processes. Certain requirements in the proposed rule are also intended to improve data accessibility for patients, providers, and payers.Read More »