A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

In June, CMS announced plans for an experimental Medicare model known as the Wasteful and Inappropriate Service Reduction ...

Beginning Jan. 1, 2026, 17 medical procedures will require prior authorization for patients under the traditional Medicare ...

As the year comes to a close, the Trump administration seems to be going in two different directions when it comes to the use ...

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 ...

Prior authorization — in which a patient needs approval from the health plan before proceeding with a medical service — has long created a rift between payers and providers. It has gotten such a bad ...

Of the many tools that payers use to control costs, prior authorization ranks high on the list of what providers and patients find particularly vexing. However, Health Care Service Corporation hopes ...

In a recent survey, 84% of providers reported the number of medical services that require prior authorization has increased. And 62% of providers reported that they do not have the technology to ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

A CMS pilot program that would add prior authorization for some traditional fee-for-service Medicare services has come under increased scrutiny by some members of Congress, including a call to pause ...