DAILY UPDATE: Prior Medical Authorizations Up as Stock Markets Rise to Record Highs!

By Staff Reporters

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A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure. The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.

CITE: https://www.r2library.com/Resource

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 52.42 points (1.1%) to 4,958.61, up 1.4% for the week; the Dow Jones Industrial Average gained 134.58 points (0.4%) to 38,654.42, up 1.4% for the week; the NASDAQ Composite rallied 267.31 points (1.7%) to 15,628.95, up 1.1% for the week.
  • The 10-year Treasury note yield (TNX) surged about 16 basis points to 4.024%.
  • The CBOE Volatility Index® (VIX) fell 0.04 to 13.84.

The market’s strength continued to be driven by the biggest companies, while smaller names lagged. The small-cap Russell 2000® Index (RUT) fell 0.6% Friday and posted a drop of 0.8% for the week. In other markets, the U.S. dollar index (DXY) rose 0.8%, reaching its strongest level in nearly two months, amid expectations interest rates will remain elevated, which boosted demand for dollar-denominated assets, such as Treasuries.

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PODCAST: Health Insurance Prior Medical Authorization Rates Are Down

BUT MEANINGFUL?

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource

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MEDICAL PRIOR AUTHORIZATION: Proposed Modernization from CMS

By Health Capital Consultants, LLC

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CMS Proposes Modernizing Prior Authorizations

On December 6, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed a modernization of the prior authorization process for health insurance. The proposed rule seeks to require certain insurers to implement electronic prior authorization, shorten decision timeframes, and make the process more transparent and efficient.

CITE: https://www.r2library.com/Resource/Title/082610254

The rule includes “five key provisions and five Requests for Information,” aiming to “improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.” This Health Capital Topics article will review those provisions and requests for information, as well as stakeholder responses to the proposals. (Read more…)

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PODCAST: How Extensive is Healthcare Prior Authorization?

A New Study

BY ERIC BRICKER MD

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RELATED: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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MORE: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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AMA: Prior Authorization and Patient Harm?

By Staff Reporters

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Prior Authorization and Patient Harm

 •  34% of physicians report that PA has led to a serious adverse event for a patient in their care.
 •  24% of physicians report that PA has led to a patient’s hospitalization.
 •  18% of physicians report that PA has led to a life-threatening event or required intervention to prevent  permanent impairment or damage.
 •  8% of physicians report that PA has led to a patient’s disability/permanent bodily damage, congenital anomaly/birth defect or death.

Source: AMA, “2021 AMA prior authorization (PA) physician survey,” February 2022

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PODCAST: What is a Medication Formulary?

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About First Stop Health | Telemedicine

By Eric Bricker MD

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Why Are Certain Medications Non-Formulary?

What Are Formulary Tiers and Its Rules?

Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.

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PODCAST: https://www.youtube.com/watch?v=kEjDBp9HdBk

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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Update on Medical “Prior Authorization”

Survey Highlights on Pre-Certification

By wedi

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Product Details

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On Prior Authorization [PA]

A Physician Survey CIRCA: 2018

[By AMA]

DEFINITION: Prior authorization is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost-saving measure although it has received criticism from physicians for being costly and time-consuming.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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A Prior Medical Authorization Survey

A Physician Survery

By AMA

DEFINITION: Prior authorization is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost-saving measure although it has received criticism from physicians for being costly and time-consuming.

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MORE: https://apple.news/ARVNHupiLTq6pqLFEmhvS5Q

Conclusion

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