Podcasts about prior authorization

The Big Unlock Podcast · Transforming Prior Authorization with AI – Podcast with Siva Namasivayam He shares how AI is being applied to reduce administrative delays, including the use of generative AI to summarize clinical data and intelligent agents to assist with scheduling and information retrieval processes. The conversation also touches on enabling real-time approvals for a majority of cases, designing algorithms informed by physician input, and navigating the shift to remote work. The discussion offers insight into how technology can address systemic inefficiencies while maintaining clinical oversight. Take a listen.

Months into the 2025 state legislative sessions, how are the key issues of prior authorization, scope of practice, and physician wellness playing out? What themes are emerging and how are they different than those of previous years?  Led by AMA President Dr. Bobby Mukkamala, this panel of AMA Advocacy Resource Center attorneys talks about how the AMA is working with national, state and specialty medical societies to address these key legislative priorities.     ⭐⭐⭐⭐⭐

The Medicare Advantage Minute segment once again illustrates the fact that very few appeals were filed by MA victims of prior authorization refusals. However, the majority of those appeals resulted in reversals of the denials! In "Your Medicare Benefits 2025" we learn how Medicare covers insulin, including the newly created $35 monthly out-of-pocket limit! Moments before recording time a plea for assistance arrived from a victim of the barrage of MA plan brutality that happens to everyone who turns age 65. After hearing a radio interview he decided to emerge from hiding and take a chance on Medicare for the Lazy Man. Finally, How can one appeal a Part D lifetime late enrollment penalty? Just listen to find out! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

What policies does the American Medical Association support? What does the American Medical Association fight for? What are the biggest struggles doctors face today? American Medical Association CXO Todd Unger hosts.

How do you know if something needs prior authorization? Why does prior authorization take so long? What is electronic prior authorization? Discussing how to speed up prior authorization process using informatics in health care, HL7 and FHIR, computerized physician order entry, and more with Viet Nguyen, MD, chief standards implementation officer for HL7 International. American Medical Association CXO Todd Unger hosts.

Glidian, now part of the Infinx family, brings cutting-edge automation to the prior authorization process, helping providers significantly reduce denials and improve cash flow. In this episode, co-founder Ashish Dua shares how Glidian's technology simplifies payer interactions, boosts staff efficiency, and expands patient access across labs, radiology, and emerging care verticals.

In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Jeremy Friese, CEO of Humata Health, about prior authorization and how Humata is helping from “both sides of the fax machine.” Friese also discusses his thoughts on the future of AI adoption, how the regulatory landscape looks, and more. He also shares what the transition between physician to entrepreneur was like, what it's like to found and grow companies, and how to select the right VC partners. Links from this episode:  HealthEdge  .406 Ventures Humata Health  

Why is relating to patients important? How do you treat brain cancer? What is brain cancer treatment like? What are the benefits of understanding patient experience? AMA President-elect Bobby Mukkamala, MD, shares his personal journey from brain tumor diagnosis through recovery. Dr. Mukkamala discusses how being a patient reshaped his views on health care, the challenges of understanding a cancer diagnosis, the importance of family support—and how these experiences align with AMA priorities like prior authorization reform and addressing physician shortages. American Medical Association CXO Todd Unger hosts.

“We exist to solve prior authorization so patients can get the care they deserve,” says Dr. Jeremy Friese, founder and CEO of Humata Health. Friese joins Bloomberg Intelligence health-care analyst Jonathan Palmer to discuss how Humata’s AI-driven technology is transforming one of health care’s most notorious administrative headaches. They cover how Humata connects deeply into medical records, helps both providers and payers streamline approvals and is expanding into specialty pharmacy. Friese also shares his journey from Mayo Clinic radiologist to serial entrepreneur — and why he believes solving back-office burdens can unlock better patient care.See omnystudio.com/listener for privacy information.

What are the outcomes of prior authorization patients? How do insurance companies use AI? How does prior authorization work? Who is responsible for getting pre authorization? AMA President Bruce A. Scott, MD, shares key takeaways from the AMA's recent prior auth survey, discusses physicians' concerns about prior authorization in healthcare, how prior authorization negatively impacts employers by reducing employee health and productivity. American Medical Association CXO Todd Unger hosts.

Michael chats with Dr. Colin Banas, Chief Medical Officer at DrFirst. Together, they discuss automating and modernizing prior authorization workflows to speed access to critical drugs; challenges and opportunities in how providers, payers, and pharmacies share medication data and orchestrate prescription workflows across different systems; and advances in AI that can make a real difference for clinicians in practical, measurable ways.

Despite advancements in healthcare technology, prior authorization still relies on fax machines, phone calls, and manual data entry. In this episode, Jennifer Glockzin breaks down the daily challenges providers face with TPAs, intent-to-deny notices, and unaffiliated provider referrals—revealing where automation can finally bridge the gaps in patient access and revenue cycle management.

In this episode, Dr. Jeremy Friese, Founder and CEO of Humata Health, joins the podcast to discuss how his company is tackling the complex challenges of prior authorization through AI-driven solutions. He shares insights on the evolving healthcare landscape, the role of technology in reducing administrative burdens, and his advice for entrepreneurs looking to drive meaningful change in the industry.

Montanans could face fewer hurdles getting their insurance to cover medications and treatments.

Discover how AI and automation are transforming workflow optimization for orthopedic imaging centers. In this episode, Samantha Towler, Ancillary Patient Services Manager from Tennessee Orthopedic Alliance shares insights on leveraging technology to streamline prior authorization, reduce administrative burden, and improve operational efficiency in imaging workflows.

Governor Mike Braun is tasking his wife, First Lady Maureen Braun, with keeping Indiana's Dolly Parton Imagination Library program alive. A bill that would have made street camping illegal died in the Indiana House. The Indiana Senate approved a stripped down version of a prior authorization reform bill Thursday. Governor Mike Braun says he'll veto major property tax reform legislation if it doesn't "improve" as the session continues. Want to go deeper on the stories you hear on WFYI News Now? Visit wfyi.org/news and follow us on social media to get comprehensive analysis and local news daily. Subscribe to WFYI News Now wherever you get your podcasts. WFYI News Now is produced by Drew Daudelin, Zach Bundy and Abriana Herron, with support from News Director Sarah Neal-Estes.

In this episode of RCM Insights, we explore how GenAI Agents and automation are transforming prior authorization. Jason Adams, President of Ni2, and Navaneeth Nair, Chief Product Officer at Infinx, reveal how providers can use technology to stay ahead as payers scale AI-driven processes.

Who is responsible for getting pre authorization? How can pharmacists help doctors? What can the technician do to help expedite prior authorization? Our guests from Geisinger Health System are Kristen Kruszewski, director of pharmacy strategy, Seth Gazes, associate vice president of pharmacy strategy and planning, and Jerry Greskovic, vice president of ambulatory pharmacy services. American Medical Association CXO Todd Unger hosts.

In this episode of Healthcare Americana, host Christopher Habig speaks with Julie Baak, a practice manager at the Arthritis Center in St. Louis, about the challenges of patient access to infusion therapy and the manipulative practices of insurance companies. Julie shares her experiences managing a large number of infusion patients and the burdens imposed by insurance companies and pharmacy benefit managers. She discusses the role of social media in advocating for patients and how independent clinics can take back control of healthcare. The conversation highlights the need for reform in the healthcare system and the importance of patient-centered care.More on Freedom Healthworks & FreedomDocSubscribe at https://healthcareamericana.com/More on Julie Baak & STL Arthritis CenterFollow Healthcare Americana: Instagram & LinkedIN

Ankit Jain, CEO and cofounder of Infinitus Systems, Inc, joins Julie Yoo, a16z Bio + Health general partner, to discuss Infinitus's work in solving one of healthcare's most pressing challenges: workforce shortages. Leveraging LLMs and AI voice agents, Infinitus automates repetitive tasks, such as benefits verification and prior authorization, freeing up human talent for higher-value roles. Ankit reflects on the company's journey—from early proof-of-concept calls to scaling over five million patient-centric interactions—and shares their approach to mitigating the risks of AI errors through layered guardrails. More in "The Opportunity for Healthcare in a Post-LLM World":Super Staffing in Healthcare with Munjal ShahTransforming Clinical Trials with Alexander Saint-AmandPlus:Learn more about a16z Bio+HealthLearn more about & Subscribe to Raising HealthFind a16z Bio+Health on LinkedInFind a16z Bio+Health on X

Prior Authorization is a not a popular topic. In fact, we have not found many organizations willing to talk about it. Simply put, it is a complex challenge. We were pleasantly surprised when Frank Harvey, the CEO of Surescripts was willing to come on-camera to share the work they are doing in this area. Surecripts is collaborating with Cleveland Clinic and OptumRx to streamline the prior authorization process. What used to take days or hours can now be completed in seconds – without changing physician workflows. This is possible through careful coordination of data between the provider, payer, and Surescripts. This advancement not only ensures patients can access critical therapies sooner, but also reduces provider burnout. For now, this process is only for a limited number of therapeutic areas, but Surescripts plans to expand to more in the coming year. Learn more about Surescripts at https://surescripts.com/ Find more great health IT content at https://www.healthcareittoday.com/

What does the American Medical Association do? Are private practices closing? When do Joy In Medicine applications open? What's the new CMS rule on prior authorization? AMA President Bruce A. Scott, MD, joins to discuss the pressing issues facing physicians like Medicare payment reform, scope creep, prior authorization hassles, and the ongoing crisis of physician burnout. He highlights American Medical Association successes over the past year and how the AMA will fight for physicians and help patients in 2025. AMA CXO Todd Unger hosts. 

In our final episode of season 4, we look ahead to 2025 and beyond, with AMRPA's policy team. Our guests are Kate Beller, President of Government Relations and Policy, Troy Hillman, Director of Quality and Health Policy, and Joe Nahra, Director of Government Relations and Regulatory Policy. Read more about AMRPA's Policy Priorities on our website. This episode is hosted by Patricia Sullivan, AMRPA Director of Content & Marketing.

What does the AMA advocate for? What does the AMA do? Is Medicare reducing payments to doctors? Are there telehealth exemptions in 2025? Todd Askew, senior vice president of advocacy at the American Medical Association, joins from the AMA State Advocacy Summit to outline the AMA's top priorities for 2025. This includes reversing Medicare payment cuts, extending telehealth policies, fixing prior authorization issues to reduce administrative burdens for doctors, as well as continuing grassroots and physician engagement with elected officials to support key healthcare policies. AMA CXO Todd Unger hosts.

The death of UnitedHealthcare's CEO has reignited backlash against health insurance practices, particularly prior authorization rules. This episode explores the parallels between today's outrage and the late 1990s backlash. Archelle sits down with Dr. Lee Newcomer, a fellow former Chief Medical Officer at UnitedHealthcare during that era, to share their unique insights. Together, they examine the pros and cons of prior authorization policies and discuss the urgent need for reforms to enhance access to medical care and restore public trust in the healthcare system. Key Takeaways: A Recipe for Navigating Your Prior Authorization Step 1: Have 5-7 days of patience. Step 2: After 5-7 days, call your doctor's and verify that the prior authorization was submitted. Make sure all the info is correct. Step 3: Call customer service and ask for the status of the request. If they don't have an answer, get a commitment on when they will follow up. Mention your intention to contact the Attorney General's Office Step 4: Escalate if there is no follow up within the time promised. Options (you can do all 3) ·     Call the Health Insurance Company CEO and request a referral to the Expedited Appeal Unit ·     Contact the Human Resources Department of your employer ·     Submit a complaint to the Attorney General's office in your state. Here's a link for the AG in each state: https://projects.propublica.org/claimfile/   Don't Forget: Keep your calm and be rationale. You'll get more accomplished that way. If your doctor believes that the medical test or procedure you need is urgent or emergent….don't wait for the prior authorization. Get the medical care you need and if its denied, you can appeal it later. Links: Attorney General Offices in each state State: https://projects.propublica.org/claimfile/ Connect with Archelle ArcHealth Newsletter: https://www.archellemd.com/newsletter Email: SpeakUpForYourHealth@gmail.com Instagram:  https://instagram.com/speakupforyourhealth Facebook: https://www.facebook.com/speakupforyourhealth

In this pre-recorded session, Infinx experts Lora Pada, Prachi Sharma, and Nishant Kakkar discuss the operational challenges PT/OT and orthopedic practices face with insurance verification and prior authorization. Learn how automation and AI are transforming workflows to drive efficiencies and improve practice performance.

This week, we want to take the opportunity to revisit our conversation with Iowa State Representative Megan Srinivas. She and co-host Ryan Coonerty talk about her journey as the child of immigrants in a small Iowa town, to a life changing visit to Kenya, to Harvard, and back to Iowa to represent disadvantaged communities. They discuss her storytelling strategies to create a middle ground on key issues like abortion and why medical professionals are well-positioned to run for office. Srinivas also explains how she embraces the diverse experiences of Iowans to align her messaging on key policy issues with people's needs. Tune in to learn about her big policy ideas rooted in her unique background and how she balances her medical and legislative duties. Enjoying An Honorable Profession? Subscribe to our YouTube channel for more great content! https://www.youtube.com/@NewdealleadersOrg/ • [01:06] An introduction to Iowa Representative Dr. Megan Srinivas and what motivates her to work in the legislature while practicing medicine. • [05:30] Her work to improve the Prior Authorization policy in the form of a bipartisan bill. • [07:42] A trip to rural Kenya that transformed how she relates to others. • [09:17] Formative experiences that sparked Dr. Srivas's interest in global health and policy. • [13:02] Applying global practices to rural Iowa by adopting a broader interpretation of healthcare. • [16:42] Reframing key policies in order to create a middle ground with those who disagree. • [19:38] Iowa's identity as a Purple State and what it takes to connect with Iowans. • [22:35] Predictions for 2024 and the messaging necessary to move the needle. • [24:45] Advice for healthcare practitioners who might want to run for office. • [26:01] How being a medical professional has helped Dr. Srinivas to build relationships. • [29:23] The dearth of mental health support and facilities in Iowa and what needs to change. • [31:46] Why there is an education crisis in Iowa and how this could be solved. • [33:22] How Dr. Srinivas chooses to focus her energy in order to enact change.

In the final AMA Update episode of 2024, American Medical Association CXO Todd Unger looks back on another year of stories about the work that physicians are doing across the country and how the AMA is fighting to support them.

Have you ever eaten at Bud Harkert's in Omaha? Let us know! The numbers are growing: more participants are being lured and/or forced into Medicare Advantage plans and more participants are falling victim to "care rationing". Forty-six million episodes of denial in 2022 alone! The pervasive effects of our current inflationary trends are illustrated in a review of the Medicare supplement rate increases imposed on participants during recent months. A soon-to-be client refers to me as a "very busy national figure" who may not have time to attend to his concerns in the future. I reassured him that: After he buys the best available insurance from me, like General Eisenhower on D-Day, I would soon become the least important man in his life. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: .https://www.MedicareForTheLazyMan.com.

In this pre-recorded session, Yagna Velu dives into how Infinx leverages AI and automation to streamline prior authorization workflows. Learn about the role of system, user-defined, and audit work queues in enhancing efficiency and reducing manual intervention for processing cases. This is just the first part of his Buyer Enablement session.  We can get another episode of that session in the coming weeks. Brought to you by www.infinx.com

This episode of the RCM Insights series dives deep into the role of automation in streamlining prior authorization processes. Explore how advanced technologies like APIs, RPA, and machine learning transform efficiency, reduce errors, and improve turnaround times, with insights on real-world applications and future innovations in revenue cycle management. Brought to you by www.infinx.com

This time on Code WACK! Imagine learning that your baby girl has a brain tumor that's causing seizures and disrupting her development, and your health insurance company is denying coverage for the treatment her pediatric oncologist says she needs to survive and thrive? What would you do? Where did one mother turn when repeated health insurance denials delayed time-sensitive treatment to shrink her baby's tumor?  To find out, we spoke to Dr. Eunice Stallman, a psychiatrist in Idaho and clinical faculty at the University of Washington School of Medicine and the University of Washington Boise Psychiatry Residency Program. Her daughter Zoey is two years old now and still undergoing medical treatment. This is the first episode in a two-part series. Check out the Transcript and Show Notes for more!  

In this episode of Revenue Cycle Optimized, Aakarsh Sethi, Senior Product Manager at Infinx, delves into the game-changing advances in Intelligent Payor Mapping automation. Learn how this innovation reduces onboarding times, enhances accuracy, and expands automation capabilities, ultimately transforming the way prior authorizations are processed. Tune in for a glimpse into the future of healthcare automation and efficiency. Brought to you by www.infinx.com

A troubling disconnect between medical expertise and insurance mandates is putting patients' health at risk. Policies like step therapy and prior authorization are forcing individuals into treatments not recommended by their doctors—often with devastating consequences. In this episode, we hear from a patient who endured months of suffering due to her insurer's 'fail-first' requirements. We also talk with a doctor navigating this impossible system and a biotech leader fighting to ensure innovative treatments reach the patients who need them most. Follow us on LinkedIn, X, Facebook and Instagram. Visit us at https://www.bio.org/

  Your clients may not be aware of extra benefits in select Medicare Advantage plans. Learn about OTC benefits and how you can educate your clients about them.   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.   Resources: How to Ask Your Current Clients for Referrals: https://ritterim.com/blog/how-to-ask-your-current-clients-for-referrals/ Register with Ritter Insurance Marketing: https://app.ritterim.com/public/registration/ Signs It's Time to Expand Your Insurance Portfolio & Make the Move: https://link.chtbl.com/ASG605 The Insurance Agent's Guide to Generating Referrals FREE eBook download: https://ritterim.com/insurance-referral-generation/ Understanding Medicare Advantage Training: https://ritterim.com/knight-school/solid-foundation/understanding-medicare-advantage/1/   References: GA Foods, GA Foods, www.gafoods.com/. Accessed 16 Aug. 2024. Freed, Meredith, et al. “Medicare Advantage in 2024: Enrollment Update and Key Trends.” KFF, KFF, 8 Aug. 2024, www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-enrollment-update-and-key-trends/. Freed, Meredith, et al. “Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization.” KFF, KFF, 8 Aug. 2024, www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/. “Medicare Monthly Enrollment.” Centers for Medicare & Medicaid Services Data, Centers for Medicare & Medicaid Services, 16 July 2024, https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment. Mom's Meals, Mom's Meals, www.momsmeals.com/. Accessed 16 Aug. 2024. SilverSneakers, SilverSneakers, https://tools.silversneakers.com/. Accessed 16 Aug. 2024. “Silver&Fit.” Silverandfit.com, Silver&Fit, www.silverandfit.com/. Accessed 16 Aug. 2024. Levy, Alexis, et al. “Supplemental Benefit Trends 2023.” HealthScape, Chartis, 14 Feb. 2023, www.healthscape.com/insights/supplemental-benefit-trends-2023/. Badger, Cary. “The Rise of Over-the-Counter Programs in Medicare Advantage Plans.” HealthScape, Chartis, 30 Apr. 2019, www.healthscape.com/insights/the-rise-of-over-the-counter-otc-benefits-in-medicare-advantage/.   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance    Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/

On this episode of Managed Care Cast, we're talking with Benjamin Ukert, PhD, of Elevance Health's Public Policy Institute. His study, "Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer," evaluated prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.

Insurance barriers can delay access to necessary medications. In this conversation, David shares his personal journey with osteoporosis, a condition often perceived as a women's disease, and the challenges he is encountering to get the medication he needs. Key Takeaways Men are risk for osteoporosis. It is not just a women's disease. Be proactive: Routine screening for osteoporosis is not recommended for men. So, men with a family history of osteoporosis and/or fractures after minor trauma should proactively request a bone density text, call a DEXA scan Always (always) request a copy of a healthcare denial letter. Don't just accept a verbal communication. Insurance companies are required to put every denial in writing and include the contractual reason for the denial. Share your story with Archelle Newsletter: https://www.archellemd.com/newsletter Email: SpeakUpForYourHealth@gmail.com Instagram:  https://instagram.com/speakupforyourhealth Facebook: https://www.facebook.com/speakupforyourhealth

Send us a textNearly all insured Americans have prescription medication benefits.So why are so many Americans struggling to afford those prescriptions?Shouldn't these benefits cover the cost? In this episode of CareTalk, David Williams speaks with Kyle Kiser, CEO of Arrive Health, to explore the factors driving the disconnect between consumer needs and prescription pricing, and how point-of-prescribing technology can serve as a patient-centered solution. This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.TOPICS(0:17) Sponsorship(2:01) Why Is Medication Access an Issue?(4:23) What Happened to Affordable Medicine?(5:14) The State of Prior Authorization(7:08) Why Hasn't Electronic Prescribing Solved Consumer Constraints?(8:58) What Is Patient-Centered, Provider-Friendly Tech?(13:18) The Issues with Preferred Pharmacies(15:34) How Have Pharma Support Programs Evolved?(18:12) The Role of Biosimilars in Reducing Prices(19:38) What Should a Patient Know When Dealing with Prescription Costs?

Speeding up prior authorization: What is the gold card program? How does prior authorization affect patients? What is prior authorization in healthcare? Ezequiel (Zeke) Silva III, MD, a radiologist at the South Texas Radiology Group, the chair of the Texas Medical Association (TMA) Council on Legislation and member of the AMA Council on Medical Service, joins to discuss the Texas Gold Card Law, its impact on the prior authorization process, as well as the TMA's and AMA's ongoing advocacy efforts to improve health care legislation. American Medical Association CXO Todd Unger hosts.

Medicare Advantage Minute consists of an article decrying the increase in prior authorization denials. Of 46 million prior authorization requests, over 3 million (7+%) were denied in 2022. "Medicare" on the Wikipedia page discusses criticisms of Medicare and the principles behind having participants of various ages contribute to the cost of the program. Finally several clients write in with questions related to drug plans and Medicare supplement plans offering discount gym memberships.  Spoiler alert: the gym membership deal through an AARP sponsored plan did not work out so well! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Why do prior authorizations take so long? Is prior authorization required for emergency services? Why would insurance deny a medication? Melissa Garretson, MD, a pediatric emergency physician at Cook Children's Health Care System and a member of the AMA Board of Trustees, discusses how to talk to patients about prior authorization, why prior auth takes so long, and how the AMA is fighting to fix prior authorization. American Medical Association CXO Todd Unger hosts.

Photo by National Cancer Institute on Unsplash […] The post Prior Authorization appeared first on HealthCetera.

Medicare Advantage may be radically altered if a proposed new law passes. Prior Authorization will be required for Prior Authorizations! Gee, what genius came up with this plan? New business rates are creeping higher in these inflationary times. Rate increases for the rich plan are hitting insureds harder than those for the High Deductible plans that MLM recommends for almost everyone! On the Wikipedia page for Medicare we learn about deductibles and coinsurance for Parts A & B. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Imagine mobilizing a community of doctors and patients to spark change in the health care system. In this episode, Dr. Nisha Mehta and Dr. Tina Shah share how they made significant strides in addressing one of the most pressing issues in health care today: prior authorizations. They share how they mobilized a vast community of doctors to tackle the pressing issue of prior authorizations and their detrimental impact on patient care. Listen in to learn about the powerful role of physician-patient alliances, the significance of sustained advocacy, and how a focused community can drive monumental change in health care. Learn more about your ad choices. Visit megaphone.fm/adchoices

This time on Code WACK! What is the true cost of the American health insurance system? What toll is it taking on both patients and providers?  And what do we need instead? To find out, we recently interviewed Dr. Linda Peeno, a physician, ethicist and health insurance industry whistleblower who testified before Congress and who has spent nearly four decades working to protect patients from harm and death by corporate healthcare systems.  Dr. Peeno was played by actor Laura Dern in the 2002 docudrama “Damaged Care,” and she was also featured in Michael Moore's 2007 documentary “Sicko.”    Check out the Show Notes and Transcript for more!  

Kristen O'Brien joins Julia Grabo to discuss the latest regulatory and legislative action on prior authorization and what stakeholders should be watching for next.

Standardizing Prior Authorization Workflows Break down common bottlenecks in prior authorization processes and learn tactics to standardize workflows across various locations and practices. Hear examples of how technology is improving workflow efficiency with Senior Customer Success Manager, Stephanie Cheng. Brought to you by www.infinx.com. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

This rule-based informatics solution pulls from the electronic health record to automate the election of an appropriate biosimilar therapy based on the patient's insurance and hospital formulary preferences, streamlining prior authorization and approval processes. This e-tool decreased administrative burden to providers, pharmacists, and prior authorization specialists and increased biosimilar utilization by 21.9%. Guest: Sarah Hudson-DiSalle, PharmD, RPh, FACCC Assistant Director of Reimbursement Services The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute   “Using an EHR auto-selection tool that takes into consideration insurance preferences and contractual relationships to provide a proactive solution has helped our providers, our pharmacists, and our prior authorization specialists.”   Hear more about this innovation at the ACCC 41st National Oncology Conference, October 9-11, 2024, in Minneapolis, Minnesota.   Resources: Biosimilars Implementation Roadmap [MINI PODCAST] Ep 103: Precision Medicine: Robots, Biologics, and Advocates: Lessons from the Pharmacy Improve Oral Oncolytic Workflow and Reduce Treatment Delays with a Pharmacist Collaborative Practice Agreement Shifting Chemo Administration from Inpatient to Outpatient Setting Improves Care and Reduces Costs Reducing Revenue Loss and Patient Financial Toxicity with Pharmacy Pre-Certification and Denials Management [PODCAST] Ep 39: Biosimilars—What Patients Need to Know

A conversation with Dr. Richard Menger

Dr. Lonnie Robinson from Regional Family Medicine in Mountain Home, Arkansas explains the challenges surrounding prior authorization faced by both practices and insurance providers, and how this inspired him to become involved in state health policy advocacy. Hear how Dr. Robinson, drawing inspiration from Texas' “gold card” approach, worked with Aledade's policy committee and state legislators to pass similar legislation in Arkansas to reduce administrative workloads.   Submit your questions, comments, or episode ideas to acoshow@aledade.com