Call it a Jeni's ice cream standard, I've got a nighttime double scoop 🍨 for you: Here are the six companies Medicare picked to run its AI prior authorization pilot

And House Democrats are introducing a bill tomorrow to try to stop the program, called WISeR.

https://www.statnews.com/2025/11/06/medicare-wiser-prior-authorization-pilot-tech-vendors/

#health #healthcare #medicine #medicare #priorauth #healthinsurance #ai #artificialintelligence #WISeR #CMS #CMMI

The classic "brag about reducing prior auth on Monday" / "introduce new prior auth program on Friday" 🤘

Dr. Oz and CMS introduce a new, tech-enabled Medicare insurance approval program for fraud and waste, just days after holding a press conference talking about reducing prior auth.

#health #healthcare #healthinsurance #medicine #priorauth #cms #medicare

Key Changes You Need to Know:
• Prior Authorization: New 7-day review timeframe
• Telehealth: Home services allowed through March 31
• Therapy Services: $2,410 KX modifier threshold

📌 Prior Auth changes mean faster approvals!
📌 Extended telehealth flexibility
📌 Updated therapy service thresholds

Stay ahead of these changes! Need help implementing these updates? True Estuary Advisors is here to guide you.

#HealthcareUpdates #Telehealth #PriorAuth #TherapyServices"

Some thoughts on #PriorAuth: It’s wild to me that health insurance companies try to shield themselves from medical malpractice liability and argue that doctors are independent practitioners, not agents of the insurance company, to preserve the patient-practitioner relationship. At the same time, step therapy and prior authorization requirements get in the way of patient care since the insurance company gets involved in making medical decisions.

So I had a thought: Could we not establish a principle where insurance gets to do one or the other? Either an insurance company can have prior auth but they take on liability for malpractice, *or* they have no liability for medical decision-making but have to pay for everything that’s already covered in the policy.

And there goes our power in today's #maine storm. Can't blame #centralmainepower as it's blowing like crazy now.

Now to finish charts, calls and #priorauth requests before the various batteries run out.

#primarycare

I dont think the @OptumRx folks thought that was funny that I asked to fight directly with the main boss and skip the earlier levels. 😬

#priorauth #CardioTwitter #MedTwitter @CBallantyneMD @DrMarthaGulati @PamTaubMD @ErinMichos @DGlaucomflecken