Understanding Prior Authorization

Prior authorization in health care is a requirement that a healthcare provider gets approval from an insurance plan before prescribing their patient medication or doing a medical procedure. Insurance providers use prior authorization to make sure that a specific medical service is needed and worth the cost, and that no duplicative services are being performed.

Payers use prior authorization as a way to keep healthcare costs in check. Terry discusses the Medicare, Medicare Advantage, and Commercial Plan terms with PAs and how to make it administratively manageable. Also, a coding question on Smoking Cessation.

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