As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and strengthening access to care, the Centers for Medicare & Medicaid Services finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).
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By Thad Salido MD – The future of healthcare extends beyond treating illnesses; it’s about the ability to foresee and prevent them. With the emergence of AI and the rapid expansion of comprehensive population health data, we stand at the cusp of a healthcare revolution.
By Teri Gatchel-Schmidt – In the pursuit of delivering high-quality patient care, the complexities of healthcare management continually present challenges and regulation changes. Example, the Prior Authorization process, overloading medical staffs with administrative and resource demands.
By Matthew D. Bayley MD – Each year the Medical Group Management Association surveys hundreds of group practices to assess how industry regulations are impacting them. Just as in previous years, the most recent survey shows things are getting worse, not better.
By Chris Emper – In the final two months of 2022, CMS released over 5,000 pages of new regulations and the U.S. Congress passed into law a 4,000-plus page omnibus spending bill that had over 1,000 pages of healthcare provisions.
Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P: Fact Sheet. CMS is continuing to advance our interoperability goals and tackle process challenges related to prior authorization to increase efficiencies in health care.
By Matthew Hawley & Jonathan Starr PharmD – A patient receives automatic refills from a specialty pharmacy for a drug he no longer uses and ends up stockpiling $1 million worth of medication. A pharmacy miscalculates the number of units of a specialty drug prescribed for a patient, resulting in a claim that is $16,000 higher than necessary, yet the claim is paid for by insurance.
AMA survey shows, health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms despite mounting evidence that insurer-imposed authorizations for drugs and medical services can be a hazardous and burdensome administrative obstacle to patients.
By Alex Baker & Michael Wittie – In January 2022, ONC issued a Request for Information that sought public input on the ONC Health IT Certification Program and how it could incorporate standards, implementation specifications, and certification criteria related to electronic prior authorization.