Recently, we put together a template to help medical professionals explain a confusing process. Readers gave us very pointed feedback, so we updated it. By Ron Lieber Two months ago, I shared my tale ...

Three new studies highlighted the growing burden of prior authorization on both oncologists and patients. Findings from a survey of radiation oncologists, for instance, revealed that more than 80% ...

Many private health insurers require medical providers to get approval before administering treatment, sometimes resulting in delayed or denied care for patients. Now, that tactic, known as prior ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

Providers are betting on artificial intelligence to ease the pain point of prior authorization, a new survey shows. Cohere Health, which provides clinical intelligence to insurers and risk-bearing ...

Therapists treating Medicaid enrollees in Colorado will have to get the state’s authorization to conduct more than 24 sessions with an individual patient in a year, as the department overseeing the ...

The program, called WISeR, aims to reduce wasteful spending and fraud in the Medicare system. Doctors and Democrats have raised concerns that the pre-approval process could delay or deny necessary ...

CLEVELAND, Ohio — A new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, is set to launch next year in Ohio and five other states, potentially changing how older ...

The new Medicare initiative would apply to claims for procedures such as steroid injections for pain management, electrical nerve stimulator implants, skin and tissue substitutes, devices for ...

Insurance companies often make doctors ask their permission before treating patients. This template can help medical professionals explain how it works. By Ron Lieber Ron Lieber will update this ...

Medicare beneficiaries in ten states will soon be participating in a new prior authorization program. The Centers for Medicare & Medicaid Services (CMS) is implementing a five-year demonstration ...