In an era where data fluidity is transforming healthcare, life sciences manufacturers must stay attuned to evolving Health IT policies given that many of these policies have...
Observations from the Field: Understanding and Leveraging CMS-0057 for Strategic Advantage
In our role as health IT consultants, we consistently encounter a common issue when discussing the CMS Interoperability and Prior Authorization Final Rule (CMS-0057) with...
ONC HTI-2 Proposed Rule: Examining ePrescribing, Prior Authorization, & RTPB
In our ongoing series about the HTI-2 proposed rule, we've previously provided a high-level overview, aspects related to API certification requirements, and information blocking....
Beyond Compliance: Achieving Excellence in Execution – Mastering Iterative Improvements
The final blog in our series, focusing on Execution & Iteration, brings our compliance journey to its most dynamic phase. Read the first and second blogs in the series to catch up...
Beyond Compliance: Transforming Insights into Impact – The Journey from Analysis to Action
In the first blog of this series, we broached the complexities of the "Assess and Analyze" phase, emphasizing the importance of a thorough understanding of the regulatory...
Beyond Compliance: The Strategic Roadmap – Starting with Assessment and Analysis
The CMS rule on advancing interoperability and improving prior authorization (CMS-0057-F) sets a foundation for future policymaking. As payers embark on this compliance journey,...
Adapting to State Reforms in Prior Authorization Processes: Opportunities and Challenges for Healthcare Entities
As state legislatures intensify efforts to reform prior authorization processes, these changes may reflect broader regulatory trends such as those outlined by CMS in rules like...
CMS Rule Drives New Era of API-Enabled Data Sharing & Prior Authorization Reform
On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a long-awaited final rule aimed at advancing interoperability and enhancing prior authorization...
Washington State Takes a Leap to Require FHIR APIs and Reshape Prior Authorization
Washington State has taken a pioneering leap in reshaping the landscape of prior authorization, racing ahead of federal guidelines by mandating the use of FHIR (Fast Healthcare...
Could Gold-Carding be a Transformative Factor for Prior Authorization?
The concept of "Gold-carding” is an emerging policy trend that has the potential to significantly transform prior authorization (and claims) procedures. As an evolving concept, it...
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