Prior authorization typically takes about 10 days for Original Medicare and Part C. However, starting in 2025, CMS has reduced this to 7 days. Doctors can also request an expedited review ...

More older Americans are challenging their Medicare Advantage plan's denial of a service, and it's paying off.

The policy, CMS-1717-FC from the federal government, requires that patients with Medicare receive prior authorization to undergo these surgical procedures at hospital outpatient surgery departments.

CMS finalized a key provision that holds Medicare Advantage insurers responsible for paying inpatient hospital admissions claims previously approved through the prior authorization process.

Last year, only 26% of the provider groups UnitedHealthcare works with submitted more than one prior authorization request, Docimo said. "It may be perceived as prevalent, but it's not required in ...