Connected Health Pulse

Interoperability and Prior Authorization Are on FHIR

Electronic Health Reporter

MARCH 12, 2024

The recently released CMS Interoperability and Prior Authorization final rule is a pivotal measure to reshape the industry. By laying the groundwork for expanded access to health information and […] The article Interoperability and Prior Authorization Are on FHIR appeared first on electronichealthreporter.com.

FHIR

FHIR Interoperability Health Information

CMS finalizes rule setting prior authorization deadlines for payers

FierceHealthIT

JANUARY 17, 2024

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization d | In a Wednesday morning rule drop by CMS, the Biden Administration warned payers they will soon be required to give a reason for denying a prior authorization (..)

Medicare

Dubai Health Authority works on enhancing smart health technology services

Mobi Health News

MARCH 2, 2021

The authority said that it is currently collaborating with Enpy, a Dubai-based startup that specialises in medical artificial Intelligence (AI), to improve remote patient monitoring.

Health Technology

First OTC, app-connected COVID-19 test authorized by FDA

Mobi Health News

DECEMBER 15, 2020

Alongside step-by-step instructions, the Ellume COVID-19 Home Test's accompanying app automatically reports users' results to the relevant public health authorities.

Public Health

Cue Health receives first-ever de novo authorization for at-home COVID-19 test

Mobi Health News

JUNE 8, 2023

The company was also the first to receive emergency use authorization for its home COVID-19 test in 2021.

Prior Authorization Takes a Leap Forward in CMS Regulation

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. The Dilemma of Prior Authorization Prior authorization, also known as a pre-approval, strikes fear into both patients and providers. But that is an ideal far off in the future.

FHIR

FHIR Interoperability Medicare Healthcare IT

Texas passes law authorizing teledentistry

Healthcare IT News - Telehealth

JUNE 21, 2021

Greg Abbott signed a bill into law this week that formally authorized dentistry via telemedicine in the state. In March 2020, the State Board of Dental Examiners issued guidance declaring that "dentists in Texas are not authorized to practice teledentistry," according to court documents. WHY IT MATTERS.

Telemedicine

Telemedicine Public Health Healthcare IT

Prior authorization and other regulatory burdens have increased since last year, practices tell MGMA

FierceHealthIT

NOVEMBER 13, 2023

Nine in 10 polled medical practices say their regulatory burden has increased over the past year with prior authorization, audits and appeals, the Medicare Quality Payment Program (QPP) and require | The latest annual poll of practices' regulatory burden outlined prior authorization, audits and appeals, Medicare QPP and other leading pain points (..)

Medicare

Prior Authorization: How Does It Affect Payers?

BHM Healthcare Solutions

FEBRUARY 7, 2024

Prior Authorization is designed to prevent unnecessary expenses. In this blog post, we will delve into the nuances of prior authorization, exploring its effects on payers and unveiling best practices for a more sustainable and efficient healthcare system. The post Prior Authorization: How Does It Affect Payers?

Legislators urge CMS to finalize prior authorization reforms—and go further

FierceHealthIT

JUNE 22, 2023

A bipartisan group of legislators from both chambers of Congress is urging the Biden administration to finalize updates to prior authorization. | A bipartisan group of legislators from both chambers of Congress is urging the Biden administration to finalize updates to prior authorization.

DrFirst acquires Myndshft to build out prior authorization tech for specialty medications

FierceHealthIT

APRIL 18, 2024

Medication management platform DrFirst this week closed its acquisition of Myndshft Technologies, an AI-enabled benefits and prior authorization verification platform. |

10 Essential Terms You Should Know About Prior Authorization

BHM Healthcare Solutions

FEBRUARY 13, 2024

Dive into our latest insight detailing 10 crucial terms for prior authorization, essential for navigating healthcare effectively. The post 10 Essential Terms You Should Know About Prior Authorization appeared first on BHM Healthcare Solutions.

UnitedHealthcare defends controversial prior authorization policy for colonoscopies

FierceHealthIT

MAY 16, 2023

UnitedHealthcare defends controversial prior authorization policy for colonoscopies fdiamond Tue, 05/16/2023 - 16:43

CMS prior authorization rule finally crosses the finish line

Redox

JANUARY 24, 2024

My debut focused on how the CMS proposed Interoperability and Prior Authorization rule would dramatically improve prior authorization processes with electronic processing via APIs. CMS just finalized the CMS Interoperability and Prior Authorization Final Rule CMS-0057-F , or what many have called the “Interop 3” rule.

FHIR

FHIR Interoperability HIPAA

Cohere Health Raises $50 Million in Equity to Meet Increased Demand for AI-Driven Transformation of Prior Authorization Process

Healthcare IT Today

FEBRUARY 16, 2024

The latest round of funding will fuel the company’s expansion to meet the increasing demand for Cohere’s intelligent prior authorization platform. million intelligent prior authorizations annually for more than 15 million health plan members and 420,000 healthcare providers nationally.

Interoperability

Interoperability Leadership Medicare Digital Health

At least 67,000 Kaiser Permanente workers vote to authorize strike, allege bad faith bargaining

FierceHealthIT

SEPTEMBER 14, 2023

Tens of thousands of Kaiser Permanente’s workers have voted to authorize a labor strike should no contract deal be in place by Sept. 30, unions announced Thursday. | The total could grow by nearly 20,000 more as other unions tally their votes. The large nonprofit would need to reach a contract deal by Sept. 30 to avoid the walk-off.

OIG raises concern about prior authorization denials in Medicaid managed care

FierceHealthIT

JULY 20, 2023

The Office of Inspector General (OIG) is urging the feds and states to take on greater oversight of prior authorization denials in Medicaid managed care. | The Office of Inspector General is urging the feds and states to take on greater oversight of prior authorization denials in Medicaid managed care.

Can We Automate Prior Authorizations?

Healthcare IT Today

MARCH 23, 2022

Prior Authorizations are the bane of doctors existence and they affect the patient as well. Recently, I was able to sit down with Joe Anstine, CEO, and co-founder of PriorAuthNow , a company that is working to ease the tensions and difficulties of prior authorizations, to dive into this topic. Many people may not know […].

Healthcare IT

Healthcare IT Health IT

UnitedHealthcare to begin reducing prior authorizations this summer

FierceHealthIT

MARCH 29, 2023

UnitedHealthcare to begin reducing prior authorizations this summer pminemyer Wed, 03/29/2023 - 17:02

Why Haven’t Payers Automated Prior Authorizations Previously?

Healthcare IT Today

APRIL 12, 2022

One of the banes of healthcare is prior authorizations. While every doctor and medical staff I know hate prior authorizations, the payers have a good reason for them. Just mention of the phrase makes the hearts of doctors and their staff break. They want to make sure they’re paying for the proper care. It’s a […].

Healthcare IT

Healthcare IT Health IT

UnitedHealthcare, docs still at odds over prior authorization policy for colonoscopies

FierceHealthIT

MAY 30, 2023

UnitedHealthcare, docs still at odds over prior authorization policy for colonoscopies fdiamond Tue, 05/30/2023 - 17:17

Supreme Court to hear case challenging abortion pill access, FDA authority

FierceHealthIT

DECEMBER 13, 2023

At stake are access to the nation's most frequently used abortion drug and the regulatory authority of the FDA. Jackson ruling.

Prior Authorization AI and the Future

BHM Healthcare Solutions

MAY 5, 2023

Prior authorization (PA) is a process that insurance companies use to determine whether they will cover the cost of a medical treatment or medication. However, the process of prior authorization can be time-consuming and complicated for healthcare providers, leading to delays in patient care. or Prior Authorization AI.

Healthcare IT

Author Health launches with $115M to aid seniors' mental health

Mobi Health News

JUNE 29, 2023

The hybrid platform offers Medicare Advantage recipients behavioral health services and will use the funds to grow its partnerships with insurance providers.

Mental health

Mental health Medicare

Medicare Advantage Growth Aggravate Prior Authorization Burdens

BHM Healthcare Solutions

MAY 24, 2023

Medicare Advantage growth aggravates prior authorization burdens in the several ways. Most medical groups, providing care to patients with Medicare Advantage plans, must comply with more prior authorization requirements. Efforts to streamline and standardize the prior authorization process can help alleviate some of these burdens.

Medicare

Prior Authorization Process Improvements

BHM Healthcare Solutions

FEBRUARY 16, 2023

Prior authorization (PA) is a utilization management process used by some health insurance companies for determining if the patient’s health policy covers a prescribed services, like procedures, tests, or medications, before services are rendered. Calls are recorded and transcribed, focusing doctors on patient care.

Health Policy

CMS finalizes changes to Medicare Advantage star ratings, prior authorization reforms

FierceHealthIT

APRIL 5, 2023

CMS finalizes changes to Medicare Advantage star ratings, prior authorization reforms rking Wed, 04/05/2023 - 16:14

Medicare

Author Health launches with $115M to care for seniors with serious mental illnesses, substance abuse disorders

FierceHealthIT

JUNE 28, 2023

Author Health banked $115 million for its new platform offering care and treatment for Medicare Advantage members with serious mental illness and substance use disorders. Author Health banks $115 million for its new platform offering care and treatment for Medicare Advantage members with serious mental illness and substance use disorders.

Primary Care

Primary Care Medicare

Michigan Blues plan sets out to relax 20% of prior authorization requirements

FierceHealthIT

SEPTEMBER 8, 2023

Prior authorization will become less of a hassle for physicians in Blue Cross Blue Shield of Michigan’s network, BCBSM officials hope, as they roll out an effort to relax about 20% of prior authori | Blue Cross Blue Shield of Michigan unveiled an effort to relax about 20% of prior authorization requirements by utilizing technology and “gold carding” (..)

Black patients get better care when nurse practitioners have full practice authority: study

FierceHealthIT

JANUARY 18, 2023

Black patients get better care when nurse practitioners have full practice authority: study. Wed, 01/18/2023 - 15:46.

Nursing

AHA, BCBSA urge CMS to ditch 'conflicting' requirements in prior authorization reform proposal

FierceHealthIT

JULY 28, 2023

Lobbying groups representing different camps of the healthcare industry have come together to urge the Centers for Medicare & Medicaid Service (CMS) to reconsider “conflicting regulatory propos | The American Hospital Association, American Medical Association and Blue Cross Blue Shield Association penned a joint letter highlighting "conflicting" (..)

Medicare

Do masks really protect against COVID-19? Meta-analysis authors want to see more evidence

FierceHealthIT

FEBRUARY 8, 2023

Meta-analysis authors want to see more evidence fdiamond Wed, 02/08/2023 - 15:47 Do masks really protect against COVID-19?

Surveyed physicians say prior authorization harms patient outcomes, burns healthcare resources

FierceHealthIT

MARCH 14, 2023

Surveyed physicians say prior authorization harms patient outcomes, burns healthcare resources dmuoio Tue, 03/14/2023 - 11:55

Better Prior Authorization Outcomes Through “Augmented Intelligence”

Electronic Health Reporter

JUNE 26, 2019

health insurance companies have begun implementing prior authorization processes. However, shifting prior authorization […]. The article Better Prior Authorization Outcomes Through “Augmented Intelligence” appeared first on electronichealthreporter.com. Recently, major U.S.

CMS proposes certain payers implement electronic prior authorization systems by 2026

FierceHealthIT

DECEMBER 6, 2022

CMS proposes certain payers implement electronic prior authorization systems by 2026. Tue, 12/06/2022 - 17:04.

Providers press CMS to finalize prior authorization reforms to alleviate major administrative burdens

FierceHealthIT

JANUARY 17, 2023

Providers press CMS to finalize prior authorization reforms to alleviate major administrative burdens. Tue, 01/17/2023 - 17:00.

CMS proposes new Medicare Advantage and Part D reforms on prior authorization, marketing

FierceHealthIT

DECEMBER 14, 2022

CMS proposes new Medicare Advantage and Part D reforms on prior authorization, marketing. Wed, 12/14/2022 - 17:09.

Medicare

Mental health providers decry 'mind-numbing' prior authorization burdens as Senate debates reforms

FierceHealthIT

NOVEMBER 30, 2022

Mental health providers decry 'mind-numbing' prior authorization burdens as Senate debates reforms. Wed, 11/30/2022 - 13:13.

Mental health

ONC, CMS officials plot next reforms to entice adoption of electronic prior authorization

FierceHealthIT

MARCH 15, 2023

ONC, CMS officials plot next reforms to entice adoption of electronic prior authorization rking Wed, 03/15/2023 - 13:08

Prior authorization reform vital to combat nationwide clinician burnout crisis, US surgeon general says

FierceHealthIT

MARCH 9, 2023

Prior authorization reform vital to combat nationwide clinician burnout crisis, US surgeon general says dmuoio Thu, 03/09/2023 - 15:03

Kaiser Permanente union authorize strike vote amid stalled contract negotiations

FierceHealthIT

SEPTEMBER 20, 2021

Kaiser Permanente union authorize strike vote amid stalled contract negotiations. Mon, 09/20/2021 - 15:16.

Providers want more from CMS on prior authorization reform after proposed changes

FierceHealthIT

FEBRUARY 13, 2023

Providers want more from CMS on prior authorization reform after proposed changes rking Mon, 02/13/2023 - 17:36

HHS' proposed HTI-1 rule draws criticism for what's excluded—electronic prior authorization

FierceHealthIT

MAY 8, 2023

HHS' proposed HTI-1 rule draws criticism for what's excluded—electronic prior authorization aburky Mon, 05/08/2023 - 16:18

First COVID-19 diagnostic test authorized for home sample collection

Mobi Health News

APRIL 21, 2020

Using a designated kit ordered by a doctor, patients will be able to self-swab and mail their samples to LabCorp testing facilities. The self-collection kits will be available in "most states" in the coming weeks.

Interoperability and Prior Authorization Are on FHIR

CMS finalizes rule setting prior authorization deadlines for payers

Trending Sources

Dubai Health Authority works on enhancing smart health technology services

First OTC, app-connected COVID-19 test authorized by FDA

Cue Health receives first-ever de novo authorization for at-home COVID-19 test

Prior Authorization Takes a Leap Forward in CMS Regulation

Texas passes law authorizing teledentistry

Prior authorization and other regulatory burdens have increased since last year, practices tell MGMA

Prior Authorization: How Does It Affect Payers?

Legislators urge CMS to finalize prior authorization reforms—and go further

DrFirst acquires Myndshft to build out prior authorization tech for specialty medications

10 Essential Terms You Should Know About Prior Authorization

UnitedHealthcare defends controversial prior authorization policy for colonoscopies

CMS prior authorization rule finally crosses the finish line

Cohere Health Raises $50 Million in Equity to Meet Increased Demand for AI-Driven Transformation of Prior Authorization Process

At least 67,000 Kaiser Permanente workers vote to authorize strike, allege bad faith bargaining

OIG raises concern about prior authorization denials in Medicaid managed care

Can We Automate Prior Authorizations?

UnitedHealthcare to begin reducing prior authorizations this summer

Why Haven’t Payers Automated Prior Authorizations Previously?

UnitedHealthcare, docs still at odds over prior authorization policy for colonoscopies

Supreme Court to hear case challenging abortion pill access, FDA authority

Prior Authorization AI and the Future

Author Health launches with $115M to aid seniors' mental health

Medicare Advantage Growth Aggravate Prior Authorization Burdens

Prior Authorization Process Improvements

CMS finalizes changes to Medicare Advantage star ratings, prior authorization reforms

Author Health launches with $115M to care for seniors with serious mental illnesses, substance abuse disorders

Michigan Blues plan sets out to relax 20% of prior authorization requirements

Black patients get better care when nurse practitioners have full practice authority: study

AHA, BCBSA urge CMS to ditch 'conflicting' requirements in prior authorization reform proposal

Do masks really protect against COVID-19? Meta-analysis authors want to see more evidence

Surveyed physicians say prior authorization harms patient outcomes, burns healthcare resources

Better Prior Authorization Outcomes Through “Augmented Intelligence”

CMS proposes certain payers implement electronic prior authorization systems by 2026

Providers press CMS to finalize prior authorization reforms to alleviate major administrative burdens

CMS proposes new Medicare Advantage and Part D reforms on prior authorization, marketing

Mental health providers decry 'mind-numbing' prior authorization burdens as Senate debates reforms

ONC, CMS officials plot next reforms to entice adoption of electronic prior authorization

Prior authorization reform vital to combat nationwide clinician burnout crisis, US surgeon general says

Kaiser Permanente union authorize strike vote amid stalled contract negotiations

Providers want more from CMS on prior authorization reform after proposed changes

HHS' proposed HTI-1 rule draws criticism for what's excluded—electronic prior authorization

First COVID-19 diagnostic test authorized for home sample collection

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