Prior Authorization & Appeals

Medicare Advantage's AI Era Calls for New Accountability, Columbia Law Review Note Argues

George Padron
AI & Critical Decision Support, Prior Authorization & Appeals, Medicare/Medicaid Updates, Appeals & Denials Management, Reimbursement Changes | May 6, 2026
Emma Ziegler's note in the Columbia Law Review uses real cases to argue Medicare Advantage AI denials need stronger CMS transparency rules and accessible appeals.

Insurer Claims of Prior Authorization Cutbacks Draw Skepticism From Physicians and Policy Experts

George Padron
Prior Authorization & Appeals, Medicare/Medicaid Updates, Coverage Navigation Strategies, Appeals & Denials Management, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 13, 2026
AHIP says insurers eliminated 6.5M prior authorizations for medical services, but critics call the announcement vague and say prescription drugs were excluded.

Medicare's AI-Driven Prior Authorization Pilot Draws Physician Backlash and a Federal Lawsuit

Sonia Reyes
Prior Authorization & Appeals, State & Federal Regulations, Medicare/Medicaid Updates, Healthcare Headlines, Policy & Legislation, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 10, 2026
Three months into Medicare's WISeR prior auth pilot, physicians report widespread claim denials, and the EFF has sued CMS for transparency on AI vendor practices.

The Scheduling Fix Hospitals Keep Ignoring

George Padron
Prior Authorization & Appeals, Healthcare Headlines, Practice Management, Care Coordination | Apr 3, 2026
Smoothing elective hospital admissions reduces ER boarding, nurse turnover, and mortality, yet most U.S. hospitals have not adopted the proven strategy.

Vision Benefits and Medical Coverage: Network Complexity Creates Patient Confusion

Sonia Reyes
Prior Authorization & Appeals, Medicare/Medicaid Updates, Patient Support Resources, Healthcare Headlines, Coverage Navigation Strategies, Appeals & Denials Management, Patient-Reported Outcomes | Feb 3, 2026
A Medicare Advantage member faced denial for glaucoma testing when the clinic held in-network status for vision benefits but not medical coverage in the same plan.