Tag: Prior Authorization
AAHomecare throws weight behind Medicare Advantage reforms
June 19, 2026HME News Staff
WASHINGTON – AAHomecare has sent letters of support to the sponsors of legislation in the House and Senate that would reform Medicare Advantage prior authorization, claims integrity and transparency.
In its letters to Rep. John Joyce, R-Pa., and Sen. Roger Marshall, R-Kan., the organization shared how the bills would address challenges that home medical equipment (HME) providers face daily and would improve access to medical necessary equipment for Medicare beneficiaries.
“These...
CRT providers wrangle with repairs and prior auth exemption
June 19, 2026Liz Beaulieu, Editor
WATERLOO, Iowa – Complex rehab technology (CRT) providers continue to face persistent challenges with documentation and billing for wheelchair repairs, according to Dan Fedor of U.S. Rehab, who addressed the issue at the recent VGM Heartland Conference.
Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates, said repairs remain one of the most common operational pain points for providers – accounting for roughly 30% of his daily communications...
AASM comments on CMS prior authorization rule
June 17, 2026HME News Staff
DARIEN, Ill. – The American Academy of Sleep Medicine (AASM) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) supporting efforts to improve interoperability and digitize prior authorization through standardized electronic processes. CMS published the Interoperability Standards and Prior Authorization for Drugs Proposed Rule in April. AASM says electronic prior authorization and application programming interface-based data exchange have the potential to reduce care...
In brief: Benefit manager acquisition, prior auth deadline, provider revalidation
May 22, 2026HME News Staff
MIRAMAR, Fla. – Integrated Home Care Services has acquired Dina Care, combining an in-home benefit manager with an artificial intelligence (AI)-enabled care coordination and referral management platform.
Together, the companies say they form the first comprehensive in-home benefit management and technology platform for health plans and risk-bearing organizations.
“Given the mounting pressures on health plans and risk-bearing organizations—to improve outcomes, member experience,...
CMS extends prior authorization exemption deadline
May 20, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has extended the deadline to opt out of prior authorization and continue submitting requests to May 26, AAHomecare reports.
This extension only applies to suppliers that received a letter from the DME MACs in early March regarding their prior authorization exemption status.
The updated MAC notice specifies:
If you reached exemption and want to continue submitting prior authorization requests, you must submit the opt-out...
CMS takes next step to improve prior authorizations
May 11, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services has added electronic prior authorization to its Health Tech Ecosystem. The agency says health systems, hospitals, physician practices, electronic health record (EHR) vendors and digital health developers are now joining payers as a unified coalition aligned around improving electronic prior authorization.
Working groups have been formed, vendors work to streamline process
Committed working groups across these stakeholders will...
In brief: ACU-Serve’s executive boost, CMS’s next prior auth move, McKesson’s & Medline’s results
May 11, 2026HME News Staff
AKRON, Ohio – ACU-Serve has appointed Natasha Baria Mehta as president, a strategic leadership addition that the company says reflects its continued investment in growth, operational excellence and innovation across the health care revenue cycle management (RCM) industry.
In this role, Mehta will oversee operational strategy, organizational performance and long-term growth initiatives across ACU-Serve’s HME, infusion and home health divisions. She will focus on strengthening operational...
Health plans to standardize prior auth processes
April 27, 2026HME News Staff
WASHINGTON – Leading health plans will adopt a standardized approach for providers submitting electronic prior authorization requests for the majority of medical services, which they say will accelerate patient access to care and reduce administrative burdens for providers.
The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs. These services span commercial...
In brief: Dems drop MA bill, Soleo launches new brand, VGM partners with HME360
April 24, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
Dems introduce bill to eliminate prior auths for MA plans
April 23, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...