
Prior Authorizations serve as a cost containment strategy that third-party payers leverage to control costs, restrict patient access to services, testing, and medications, and ultimately discourage medical providers from ordering unnecessary medical treatment. Prior authorizations are a major source of headaches for healthcare providers across the country. Despite the intention to control costs and ensure appropriate care, the prior authorization process has been criticized for its enormous administrative burden, potential delays in necessary medical treatment, and added complexity for healthcare providers. Striking a balance between cost control and efficient patient care remains a major challenge in the healthcare industry. Join us for an insightful 60-minute webinar as we take a deep dive into the complexities of the Prior Authorization process, discuss the pearls and pitfalls, define medical necessity requirements, and demystify the intricacies of obtaining prior authorizations, ensuring a smoother workflow and higher approval outcomes in 2025.
• Discuss the major Prior Authorization Updates for 2025
• Explore the 2025 Prior Authorization requirements for Medicare Advantage Plans
• Define medical necessity and the critical role it plays in the Prior Authorization approval process
• Explore the regulatory landscape for Prior Authorizations in 2025
• Identify which insurance payers require Prior Authorizations in 2025
• Discuss methods for obtaining Prior Authorizations in 2025
• Review common challenges experienced when obtaining Prior Authorizations
• Outline successful strategies to overcome challenges with obtaining Prior Authorizations in 2025
• Discuss how to escalate and appeal Prior Authorization denials in 2025
• Share best practice compliance tips for Prior Authorizations in 2025

Toni Elhoms is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Ms. Elhoms’ expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but…