Medicare Prior Authorization for Ambulatory Surgical Centers: What You Need to Know (2025 Update) Oh, 2025. Just when you thought you’d finally made peace with paperwork, CMS pulls a rabbit out of its regulation hat—another prior authorization rule, this time for ambulatory surgical centers (ASCs) in ten of America’s biggest, boldest states. Spoiler alert: If […]

THE QUESTION: THE PATIENT HAD TOLD ME THEY’RE OK MOVING FORWARD COSMETIC AND HAVE NOW BILLED THE INSURANCE COMPANY ON THE BACKEND, FORCING US INTO THE BILLING PROCESS. ANY WAY TO AVOID THIS IN FUTURE? We were asked a really good question about insulating against patients submitting self-pay cases to their insurance after the fact- […]

Rumored to be in existence, thought not to be…rare as the Tasmanian Tiger…the mythical Medicare Authorization does indeed exist. Worse yet, you need to know how to handle it, even though it technically is not a requirement for professional service providers (AKA Docs). So…what are we talking about here? As of 2020 Medicare started requiring […]

Here’s a question for you: A doctor tells a patient they need to schedule a procedure. Whose responsibility is it to get that procedure pre-approved by insurance? Did you guess the MD?  You’re technically wrong, but in all actuality you are correct.  The patient is actually technically responsible for ensuring prior notification and approval are […]

Some pretty major changes to pre-auth requirements for BCBSIL.  This means that authorization staff will have to submit every time for approval.  Please keep in mind how this will impact booking timelines.   Notable changes:   19318 – Breast Reduction – Best practice has been to submit for pre-determination regardless so not a massive impact […]