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Tag: Prior Authorization

Rural Hospitals Deploy AI to Fight AI as Claim Denials Add Financial Pressure
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Colorado Politics, Approved, State

Rural Hospitals Deploy AI to Fight AI as Claim Denials Add Financial Pressure

By Thelma Grimes | Colorado Politics Editor’s Note: Colorado’s healthcare system is entering a period of accelerating instability — a “tsunami,” as multiple leaders describe it — driven by collapsing hospital finances, shrinking Medicaid reimbursements, disappearing services and a political fight over who is responsible for this unraveling. Healthcare Freefall is a multipart series examining how Colorado arrived at this moment, what H.R. 1 will do next and why communities across the state are bracing for deeper shocks. Rural hospitals in Colorado say they are being pulled into a technological fight they didn’t choose. Hospitals said insurance companies have deployed artificial intelligence to deny claims faster and more efficiently, and they are scrambling to adopt the...
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Joondeph: Prior authorization is gatekeeping with red tape—can RFK Jr. cut it?
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American Thinker, Approved, Commentary, National

Joondeph: Prior authorization is gatekeeping with red tape—can RFK Jr. cut it?

By Dr. Brian C. Joondeph | Commentary, American Thinker Preauthorization, also called prior authorization (PA), is a process where healthcare insurance companies must approve before paying for medications, procedures, surgeries, or other medical services.  These are usually standard and approved therapies. For medications, PA approval is required for many FDA-approved (though expensive) drugs, used according to label, meaning in accordance with the detailed package insert. MAHA rainmaker, Health and Human Services Secretary Robert F. Kennedy Jr, is trying to fix this problem. https://youtu.be/g6VoqXmiLrw?feature=shared This process started in the 1960s as part of Medicare and Medicaid’s “utilization review” to reduce unnecessary hospital stays and manage c...
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