A new pilot program from CMS will require prior authorization, or pre-approval, from insurers for certain medical procedures. The government says the program will test whether it can reduce waste, fraud, and abuse and will start rolling out next year in Ohio, Oklahoma, Arizona, New Jersey, Texas, and Washington. The program applies only to traditional Medicare. Some medical services that will face the extra prior authorization step include steroid injections, spine surgeries, and skin substitutes — treatments the government says that could cost billions in unnecessary taxpayer dollars each year. But the most controversial part of the program is how the government will make decisions on what is and isn't covered. The program contracts private AI firms to review cases, which, experts say, could lead to inappropriate denials.
In a social media landscape shaped by hashtags, algorithms, and viral posts, nurse leaders must decide: Will they let the narrative spiral, or can they adapt and join the conversation?
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