In the News
Curated coverage of prior authorization reform, denial statistics, AI in healthcare, and payer policy from leading publications — with our perspective on what it means for physician practices.
50 articles
Prior Authorization Reform Gains Momentum in States
Analysis of the accelerating pace of state prior authorization reform, including expanded gold-card programs, AI restrictions on coverage decisions, and mandatory decision timeframes.
Rate of Initial Denials of Medical Insurance Claims Continued to Rise in 2024
Kodiak Solutions proprietary data showing initial denial rates increased to 11.81% in 2024, continuing a multi-year upward trend across commercial and government payers.
Agencies Say They Won't Enforce 2024 Mental Health Parity Final Rule
Federal agencies announced non-enforcement of the 2024 Mental Health Parity Rule, shifting enforcement responsibility to states and creating regulatory uncertainty.
Prior Authorization Gold Cards Might Need a New Prescription
Investigation into the implementation challenges of gold-card programs, including payer resistance and the need for legislative refinement as programs expand beyond Texas.
New AHA Report: Hospitals and Health Systems Squeezed by Persistent Economic Challenges
AHA's annual Costs of Caring report documenting how denial management, administrative complexity, and payer behavior contribute to financial pressure on hospitals and health systems.
Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024
KFF data showing nearly 53 million PA requests submitted to MA insurers in 2024, with 4.1 million (7.7%) denied — a volume that underscores the scale of the prior authorization system.
Payer Audits, Denial Amounts Rise Again in 2025, Vendor Data Show
Vendor data showing payer audits and post-payment recoupment amounts continued to increase in early 2025, with Medicare Advantage denial rates up 4.8% year-over-year.
UHC Continues Refinement of Prior Authorization Policy
APTA update on UnitedHealthcare's ongoing modifications to therapy prior authorization policies, including a new 6-visit/8-week initial approval window for new patients.
State Laws: Prior Authorization as Well as Biomarkers
Analysis of emerging state legislation connecting prior authorization reform with biomarker testing access, reflecting the intersection of clinical science and administrative policy.
Ambient AI Doesn't Improve Efficiency Across the Board, Study Finds
Healthcare IT News coverage of research showing ambient AI documentation tools produce mixed efficiency results, performing better in some clinical settings than others.
UnitedHealthcare to Cut Prior Authorization by 10%
UnitedHealthcare announced plans to eliminate approximately 10% of its prior authorization requirements in 2025, part of a broader effort to reduce administrative burden.
UnitedHealth Vows to Reduce Prior Authorization Burden
UnitedHealth Group's public commitment to reducing prior authorization burden, including specific PA elimination targets for home health services and select medical procedures.
12 Payers Recently Fined by States
Roundup of state regulatory actions against health insurers, including fines for mental health parity violations, claims processing failures, and network adequacy deficiencies.
States Step Up: Holding Insurers Accountable for Mental Health Parity Violations
Analysis of increased state enforcement of mental health parity laws, including $75M+ in cumulative fines across New York, California, Georgia, and Washington.
States Shaping Behavioral Health Parity Enforcement: 7 Things to Know
Seven key trends in state behavioral health parity enforcement, including increased regulatory staffing, data reporting mandates, and cross-state coordination efforts.
Prior Authorization in 2025: What to Know
Comprehensive overview of the prior authorization landscape heading into 2025, including new CMS requirements, state reform trends, and payer compliance timelines.
Denial Rates Are Climbing: What Healthcare Revenue Cycle Leaders Should Be Watching in 2025
Analysis of climbing denial rates and the operational implications for healthcare revenue cycle teams, including strategic recommendations for denial prevention and management.
Medicare Advantage Denies 17 Percent of Initial Claims; Most Denials Are Reversed
Health Affairs study of MA claims data covering 30% of the market, finding 17% initial denial rate with 57% of denials ultimately overturned, but a net 7% reduction in provider revenue.
Claims Denial Rates Up, Prior Auth Denials Down in 2024: Report
Industry report showing overall claims denial rates increased in 2024 while prior authorization-specific denials declined, suggesting shifting patterns in payer denial behavior.
Does AI-Powered Clinical Documentation Enhance Clinician Efficiency? A Longitudinal Study
NEJM AI study examining the longitudinal impact of AI-powered ambient clinical documentation on clinician efficiency, finding nuanced results across practice settings.
Prior Authorization Fixes Earn Majority Support in Congress
A majority of U.S. House members — 135 Democrats and 86 Republicans — co-sponsored the Improving Seniors' Timely Access to Care Act, with support from 450+ healthcare organizations.
Agentic AI: The Race to a Touchless Revenue Cycle
McKinsey analysis of how agentic AI could cut healthcare revenue cycle cost-to-collect by 30-60% and refocus the workforce on high-value expertise and patient experience.
How AI and Automation Are Revolutionizing Revenue Cycle Operations
HFMA report on how healthcare organizations are deploying AI-driven NLP systems for automated coding, claim error detection, and eligibility verification.
Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Impacting Patient Care
AHA report finding 84% of hospitals report increasing compliance costs, with administrative costs now exceeding 40% of total hospital expenses, driven in part by denial management.
Medicare Advantage Denials Increased Before the Implementation of New Prior Authorization Rules
Analysis showing Medicare Advantage denials increased ahead of new CMS prior authorization rules taking effect, raising questions about payer behavior in anticipation of regulation.
Social Determinants of Health and Insurance Claim Denials for Preventive Care
Peer-reviewed study examining how social determinants of health correlate with insurance claim denial rates for preventive care services, revealing disparities in access.
Healthcare Leaders Optimistic That Automation and AI Will Improve Revenue Integrity
HFMA survey finding 72% of healthcare executives prioritize AI and automation investment for revenue cycle, with 46% of hospitals already using AI in RCM operations.
UnitedHealthcare Announces Broad Prior Authorization Requirements for Therapy Services
UnitedHealthcare implemented new prior authorization requirements for physical therapy, occupational therapy, speech-language pathology, and chiropractic services under Medicare Advantage plans.
Report Highlights Unforeseen Health Care Bills and Coverage Denials by Commercial Insurers
AHA report documenting how commercial insurer coverage denials and unexpected billing practices create financial burdens for both patients and healthcare providers.
9 States Pass Bills to Fix Prior Authorization
Nine states enacted prior authorization reform legislation in 2024, addressing themes including gold-carding, response time requirements, and transparency mandates.
AMA Survey Indicates Prior Authorization Wreaks Havoc on Patient Care
The AMA's 2024 survey of 1,000 physicians found practices complete 39 prior authorizations per physician per week, with 93% reporting care delays and 89% linking PA to burnout.
10 States Have Tackled Prior Authorization So Far in 2024
A mid-year update on state-level prior authorization reform efforts, including legislation in Vermont, Minnesota, Colorado, Illinois, and other states.
Congress Reintroduces Improving Seniors' Timely Access to Care Act
Bipartisan legislation reintroduced to require Medicare Advantage plans to implement electronic prior authorization, establish response deadlines, and report PA data publicly.
3 Ways AI Can Improve Revenue-Cycle Management
The AHA identifies three key applications of AI in revenue cycle management: autonomous coding, predictive denial prevention, and real-time claim optimization.
Claims Denials and Appeals in ACA Marketplace Plans in 2023
KFF analysis finding ACA marketplace insurers denied 20% of all claims in 2023 — the highest rate since marketplace launch — with less than 0.2% of denials appealed internally.
Healthcare.gov Plans Denied 20% of Claims in 2023
Coverage of the KFF finding that marketplace plans denied one in five claims in 2023, with 19% of in-network and 37% of out-of-network claims denied.
ACA Marketplace Plans See Highest Denial Rate in Nine Years
HFMA coverage of the alarming trend in ACA marketplace denial rates reaching their highest point since marketplace launch in 2014, amid a surge to 24 million enrollees.
The Impact of Nuance DAX Ambient Listening AI Documentation: A Cohort Study
Peer-reviewed cohort study measuring the impact of Nuance DAX ambient AI documentation on clinical workflow, finding reduced note-writing time but mixed efficiency results.
Payer Denial Tactics — How to Confront a $20 Billion Problem
AHA report documenting that hospitals spend nearly $20 billion annually appealing denied claims, with more than half ultimately overturned — exposing systematic payer denial tactics.
Ambient Artificial Intelligence Technology to Assist Stanford Medicine Clinicians
Stanford Medicine's deployment of ambient AI listening technology to assist clinicians with clinical note generation, reducing documentation burden during patient encounters.
AI, Algorithm-Based Health Insurer Denials Pose New Legal Threat
Bloomberg Law analysis of emerging legal challenges to health insurers using AI and algorithms to deny claims, including class action litigation and regulatory scrutiny.
CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process
CMS finalized the Interoperability and Prior Authorization Rule (CMS-0057-F), requiring payers to implement FHIR-based APIs for electronic prior authorization by January 2027.
CMS Finalizes New Electronic Prior Authorization Requirements for Payers and Providers
Legal analysis of the CMS rule requiring Medicare Advantage, Medicaid, and Marketplace payers to implement FHIR-based prior authorization APIs with specific response timelines.
Shielding the Gold Card Law: Texans Still Fight to Guarantee Gold Card Is Implemented as Intended
Texas Medical Association's ongoing efforts to ensure payer compliance with the state's gold-card law, including legislative refinements and implementation challenges.
Judge Advances Case Over Cigna Use of Algorithms to Deny Health Claims
Federal judge allows class action claims to proceed against Cigna's use of automated algorithms to deny health insurance benefits without individual medical review.
Cigna Sued Over Algorithm Allegedly Used to Deny Claims
Class action lawsuit alleging Cigna used its PxDx algorithm to deny 300,000+ claims in two months without individual medical review, with doctors batch-approving denials.
Congress Questions Cigna's Large-Scale Denial of Insurance Claims
House Energy and Commerce Committee requests corporate documents from Cigna to examine its practice of denying claims using the PxDx system without opening patient files.
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
ProPublica investigation revealing Cigna's PxDx algorithm denied over 300,000 claims in two months, with doctors spending an average of 1.2 seconds per review.
Some Medicare Advantage Organization Denials Raise Concerns About Beneficiary Access
HHS Office of Inspector General report finding 13% of MA prior authorization denials met Medicare coverage rules, raising concerns about inappropriate barriers to medically necessary care.
New Physician 'Gold Card' Law Will Cut Prior Authorization Delays
Texas became the first state to enact a gold-carding law, exempting physicians with 90%+ prior authorization approval rates from PA requirements for those services.
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