Tag: American Medical Association (AMA)
AMA works to right-size prior auths
November 12, 2024HME News Staff
ORLANDO, Fla. – The American Medical Association will consider legislative and legal actions to fight retrospective denial of payment for care that has been pre-certified by an insurer.
A 700-member House of Delegates has approved a new policy that directs the AMA to support a federal prohibition on the inappropriate denial of payment for medically necessary care that has been pre-certified by insurers and encourages the association to take legal action against insurers that engage...
AMA seeks greater oversight of MA plans
June 11, 2024HME News Staff
CHICAGO – Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates approved policies to address the need for greater oversight of health insurers’ use of prior authorization controls on patient access to care. The new policies address insurer accountability and transparency for PA denials. “Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health,” said AMA...
AMA calls for AI oversight
June 20, 2023HME News Staff
CHICAGO – The American Medical Association has adopted a new policy calling for greater regulatory oversight of health insurers using artificial intelligence (AI) to review patient claims and prior authorization requests. The newly adopted policy calls for health insurers using AI to implement a thorough and fair process that is based on clinical criteria and reviews by physicians and other health care professionals with expertise for services under review, and that has no incentive to deny...
AMA recommends oversight of TPAs
November 16, 2022HME News Staff
HONOLULU – The American Medical Association decided at its interim meeting here to recommend that third-party administrators of specialty pharmacy benefits be included in state and federal oversight efforts of prescription drug middlemen. Regulation of pharmacy benefit managers is on the rise in response to concerns that they can have a detrimental impact on the ability of patients to access affordable prescription drugs and, for specialty pharmacy benefits, TPAs provide many of the same services,...
AMA: Make diapers tax free
June 17, 2022HME News Staff
CHICAGO – The American Medical Association is calling for the removal of the sales tax on child and adult diapers, a tax levied in 36 states. The AMA is also calling for the inclusion of child and adult diapers as qualified medical expenses for health savings accounts. “Vulnerable patient populations need affordable access to diapers,” said AMA Trustee Scott Ferguson, M.D. “The fiscal impact is de minimis for states but significant for low-income patients.” Making diapers...
Are health insurers willing to reform PA process? AMA has its doubts
May 25, 2022HME News Staff
CHICAGO – The health insurance industry has made little progress in reforming prior authorization processes, according to the results of a new survey of physicians from the American Medical Association.
In January 2018, the AMA and other national organizations signed a consensus statement outlining a shared commitment to five key reforms to the prior authorization process that promote safe, timely and affordable access to evidence-based care for patients, enhance efficiency and reduce...
Medicare spending on physician services dropped in 2020
December 7, 2021HME News Staff
CHICAGO – Medicare spending on physician services fell an estimated $13.9 billion, or 14% below expected levels, in 2020, according to a new report from the American Medical Association. Despite a mid-year rebound after sharp declines early in the year, spending during 2020 never recovered to pre-pandemic levels, the report found. “Physicians experienced a significant and sustained drop in Medicare revenue during the first 10 months of the pandemic,” said Gerald Harmon, MD, president...
Medicare spending for physician services drops $9.4B in first half of 2020
March 8, 2021HME News Staff
CHICAGO – Medicare spending for physician services dropped as much as 57% below expected pre-pandemic levels in April of 2020, according to a new report from the American Medical Association.
During the first half of 2020, the cumulative estimated reduction in Medicare physician spending associated with the pandemic was $9.4 billion, the report says.
“The economic impact of the COVID-19 pandemic has placed significant financial stress on medical practices...
AMA addresses coverage, payment for telemedicine
June 11, 2014HME News Staff
CHICAGO - The American Medical Association (AMA) voted this week at its annual meeting to approve a list of guiding principles to ensure the appropriate coverage and payment for telemedicine services. “The principles aim to help foster innovation in the use of telemedicine, protect the patient-physician relationships and promote improved care coordination and communication with medical homes,” according to a press release. The principles stem from a policy report developed by the AMA's...
Study: Docs can treat simple sleep apnea
March 13, 2013HME News Staff
DAW PARK, Australia - With basic training, primary care doctors and nurses could treat simple forms of sleep apnea, according to a new study by researchers in Australia. To conduct the study, researchers at the Adelaide Institute for Sleep Health at Repatriation General Hospital followed 155 people with sleep apnea over six weeks, and found that those treated by trained primary care doctors and nurses improved just as much as those who were treated by specialists. “We're suggesting...