This rule, finalized by the HHS, through CMS, the Department of Labor and the Department of the Treasury along with the Office of Personnel Management, directly addresses bottlenecks by helping to reduce the number of ineligible disputes entering the system at a lower cost to payers and providers.
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The 2026 Quality Payment Program (QPP) exception applications are now available through December 31, 2026, at 8 p.m. ET. There are 2 types of exception applications that allow participants to indicate why they can’t report data for one or more Merit-based Incentive Payment System (MIPS) performance categories.
By Bryan M. Dunton Esq. – The No Surprises Act (NSA) was enacted to address a specific and highly visible problem: patients receiving unexpected out-of-network bills for care they did not choose and often could not avoid. In that respect, the statute has largely done what Congress intended.
By Chris Kenyon – The Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule (CMS 0057 F) is often discussed as a health plan problem to solve. Are plans compliant? Are the APIs live? Is the data finally reliable? Those are fair questions, but they’re not the only questions providers should be asking.
By Deepak Kumar – Every physician knows the frustration. A patient needs a medication or procedure. The clinical case is clear. But before care can begin, someone on staff must navigate a phone tree, fax a form, wait days for a response, and then, far too often, start the process over after a denial.
The Centers for Medicare & Medicaid Services, through its Health Tech Ecosystem, is advancing its electronic prior authorization efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements.
By Tony Schueth – I’ve spent a large part of my career working in and around pharmacy interoperability (though we haven’t always called it that), from early on with a PBM to over two decades of NCPDP standards work for various clients. It’s an area I keep coming back to, not out of habit, but because I see the gap between what pharmacists can do and what we enable them to do remains significant.
By Sarah Jane Tribble – Tory Starr is worried about the people who get medical care at Open Door Community Health Centers along California’s North Coast. “They’re the folks that work at restaurants. They’re the teacher’s aides,” said Starr, a registered nurse who became Open Door’s chief executive more than six years ago. Those patients, he said, are “really the heart and soul of rural America.”
The EHIgnite Challenge is a national ASTP/ONC innovation competition offering $490,000 to spark new innovation for tools that will export EHI into usable insights for patients, clinicians, and payers. Phase 1 NOW EXTENDED to May 20. Winners are invited to Phase 2.