ABA Health eSource (August 2023)

Amber DePrima and Alex Oliphant wrote the article “Increased Focus by CMS on Prior Authorizations within Medicare Advantage Organizations.” The Centers for Medicare and Medicaid Services (CMS) proposed and finalized revisions to the Medicare Part C and D guidelines in the 2024 Final Rule, including new regulations on the prior authorization process. This article illustrates the process and how Medicare Advantage organizations can prepare for forthcoming changes. Read the article. (subscription required)

Robert Yates and Thomas O’Neil wrote “Beyond the Seven Elements: Effective Compliance and Ethics Programs Need an Ethical North Star.” Collective guidance from relevant stakeholders makes clear that effective compliance and ethics programs require buy-in and empowerment from the top down. The governing body and executive management team must lead by example, forging an ethical North Star that aligns with organizational core values. Read the article. (subscription required)