Provider groups are calling on CMS to adopt new rules that hold MA plans more accountable for “egregious” denials while also helping to ensure the future success of the only such plans nursing homes ...

The Office of Inspector General has released a report examining prior authorization patterns from seven managed care companies, and based on the findings is urging increased oversight of prior ...

Medicare Recovery Auditors (RACs) rate of claims denials to hospitals has continued to grow, as the number of denials was up 23 percent in the most recent quarter, according to the American Hospital ...

A deep dive into the work of one Medicaid contractor is offering stark new insights into how often Medicare Advantage plans deny nursing home coverage, how they time their decisions and why it matters ...

The American Hospital Association has urged lawmakers to strengthen oversight of Medicare Advantage plans and streamline the prior authorization process, which it described as a major barrier to ...

Lawmakers and Medicare rights groups say the Trump administration is withholding details of a pilot program that will use ...

Boris Vabson ([email protected]), Harvard University, Boston, Massachusetts. Andrew L. Hicks, Harvard University. Michael E. Chernew, Harvard University. Policy makers have been paying increasing ...

The Centers for Medicare & Medicaid Services (CMS) recently announced the launch of the Wasteful and Inappropriate Services Reduction (WISeR) Model, a six-year model under the CMS Innovation Center ...

CMS is launching a six-year pilot of the WISeR Model, starting January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, which will use AI and human review to expand prior ...