The case of one Maine woman shows how prior authorization rules can block coverage for even simple, medically necessary care.

The aggravating prior authorization process includes one step that merits scrutiny and potentially regulatory action: the ...

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 ...

The American Hospital Association is urging CMS to delay its Medicare prior authorization pilot — the Wasteful and Inappropriate Service Reduction initiative — by at least six months. “This timeframe ...

Neal K. Shah argues that a growing systemic failure to recover revenue in clinics is because growing claim denials are being treated as paperwork instead of actionable data. He says that artificial ...

The program will rely on the technology to help decide if procedures are eligible for coverage, which Sen. Murray called a ...

News about community health centers has not been favorable lately. But in Pawtucket, one just reopened a clinic that will ...

The Oncology Institute, Inc. (NASDAQ: TOI) Q3 2025 Earnings Call Transcript November 13, 2025 The Oncology Institute, Inc.

The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of ...

Last week, we took a closer look at this project by interviewing Michael Westover, Providence’s vice president of population ...