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Insurance companies vow to fix prior authorization process…again

Medical Economics

Key initiatives include standardizing electronic submissions, reducing claims subject to prior authorization, and ensuring continuity of care during insurance transitions. Physicians remain cautiously optimistic, recalling past commitments with limited progress, but hope for meaningful improvements in patient care.

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Doctors, patients, insurers all frustrated with prior authorization, RFK Jr. and Dr. Oz say

Medical Economics

and Dr. Oz say Author(s): Richard Payerchin Fact checked by: Todd Shryock Key Takeaways Health insurers are committed to standardizing electronic PA submissions and reducing services requiring PA by 2026. The initiative emphasizes prioritizing patient health over corporate profits, with support from healthcare professionals and patients.

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Low-income patients face uphill battle when fighting health insurance denials, Umass research finds

Medical Economics

adults with private health insurance between 2017 and 2019. Another finding: about 40% of all denials were due to billing errors by health care providers or processing mistakes by insurers—a reminder that many denials are not based on medical necessity or policy rules, but administrative mishaps.

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5 Risk Control Considerations as Nurse Practitioners’ Scope of Practice Expands

Minority Nurse

Professional Liability Trends and Implications Professional liability trends are evolving as NPs take on greater responsibility for patient care. Where NPs have reduced or restricted practice authority to provide patient care, liability is often shared with supervising physicians (Candello, 2023).

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The Unexpected Burden of Billing for Small Behavioral Health Practices

Valant

Behavioral health providers managing both clinical care and business operations face unique challenges: complex prior authorization requirements, extensive documentation standards, and insurance coverage barriers. As patient volume increases, small inefficiencies can turn into serious issues.

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Constant credentialing and provider purges: The hidden crisis for physicians and other clinicians in U.S. health care

Medical Economics

health care Author(s): Olga Khabinskay Fact checked by: Richard Payerchin , Afton Woodward Key Takeaways CAQH ProView's frequent reverification demands lead to providers being dropped from networks, affecting patient access to care. SHOW MORE Here’s why small practices should consider outsourcing CAQH credentialing.

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How pay-first and direct primary care models are reshaping practice finances and patient experience

Medical Economics

The pay-first model improves cash flow by collecting patient payments upfront, reducing manual collections and bad-debt write-offs. Direct primary care (DPC) offers stable revenue through subscription fees, eliminating routine insurance claims and enhancing patient access.