denials

Technology hurdles, particularly lack of standardization and interoperability, often hinder the prior authorization process. Robust communication strategies can address those...

The House of Representatives is considering legislation that would reform the way payers use prior authorization. Which payers would the...

A bipartisan group of physician legislators has introduced legislation in the House of Representatives to reform payer use of prior...

"Proactive not reactive" cost containment strategies are vital for finance executives.

The measure includes a half-dozen restrictions on other PBM practices the smaller pharmacies call anticompetitive.

Republicans and Democrats agree prior authorization needs fixing, but patients are growing impatient.

Denial rates and patient collection rates are both trending in the wrong direction, according to data from Kodiak Solutions.

Is AI helping or hurting the payer-provider relationship?

The growing tension between payers and providers is no secret. And it's forcing CFOs to take action.

Medicare Advantage is exacerbating providers' financial and operational problems, making the current path almost untenable, say hospital CEOs.

Providers' frustration with the private program is palpable, but there are actions they can take to alleviate its consequences.

Living with Medicare Advantage can be draining for your organization, but it doesn't have to feel hopeless.