Prior Authorization

CMS Releases Interoperability and Prior Authorization Final Rule

January 17, 2024 - The Centers for Medicare & Medicaid Services (CMS) has finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). The rule outlines requirements to streamline health information exchange (HIE) and prior authorization processes for Medicare Advantage (MA) organizations, Medicaid and the Children’s Health...

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EHR Work Associated With Clinician Burnout Across Specialties

by Hannah Nelson

Perceived EHR work stress was significantly associated with clinician burnout across all specialties, according to a study published in JAMIA. Researchers invited attending physicians at UC San Diego...

HIA Calls on Congress for Healthcare Interoperability, ePA Legislation

by Hannah Nelson

With the commencement of the 118th Congress, Healthcare Innovation Alliance (HIA) urged the House and Senate to take action on several issues to improve care delivery, including healthcare...

HHS Proposes New Data Standards for Electronic Health Data Sharing

by Sarai Rodriguez

The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have proposed a new rule to implement data standards, which would improve the electronic...

HL7 Calls on NCVHS to Designate FHIR as Clinical Attachments Data Standard

by Hannah Nelson

In a recent letter, Health Level Seven International (HL7) called on the National Committee on Vital and Health Statistics (NCVHS) to include FHIR as a data standard for electronic clinical...

Incomplete Patient Data Delays Prior Authorization for Specialty Medications

by Hannah Nelson

Nearly two-thirds of prescribers report that inaccurate and incomplete patient data is a top challenge to obtaining prior authorization for specialty medications, according to a new Surescripts survey...

HL7 FHIR Accelerator Launches Pilot for Oncology Prior Authorization

by Hannah Nelson

Evernorth, the health services business of Cigna Corporation, and Varian, a Siemens Healthineers company, are collaborating to enhance health data interoperability for prior authorization in oncology...

Interoperability, User-Centered EHR Design Key to Tackling Clinician Burnout

by Hannah Nelson

Health data interoperability and user-centered EHR design can help address administrative burdens that contribute to clinician burnout, according to an advisory from Vivek Murthy, MD, MBA, Surgeon...

How ONC Can Improve Electronic Prior Authorization Data Standards

by Sarai Rodriguez

A Health Information Technology Advisory Committee (HITAC) task force released 13 recommendations to ONC, suggesting ways the ONC Health IT Certification Program could incorporate data standards...

CAQH CORE Releases Guidelines to Improve Information Exchange

by Sarai Rodriguez

CAQH CORE, the author of national operating rules for the HIPAA-covered administrative transactions, recently released new operating rules to enhance information exchange and healthcare operations...

WEDI: ONC Health IT Certification Should Require ePA Data Exchange

by Hannah Nelson

The Workgroup for Electronic Data Interchange (WEDI) recently submitted a letter responding to an ONC electronic prior authorization (ePA) request for information, noting that the ePA component of the...

ONC Calls for Input on Electronic Prior Authorization Data Standards

by Hannah Nelson

ONC has released a Request for Information (RFI) seeking public input on electronic prior authorization data standards, implementation specifications, and certification criteria that could be adopted...

Increased Health IT Clinician Burden Calls for Greater Interoperability

by Hannah Nelson

While almost half of pharmacists and two-thirds of prescribers reported an increase in health IT use over the past 18 months, further interoperability efforts are needed to address clinician burden,...

Understanding Electronic Prior Authorization EHR Integrations

by Hannah Nelson

As healthcare stakeholders investigate ways to leverage health IT to mitigate clinician burden and improve patient safety, the next frontier for the digital health transformation could be streamlining...

Electronic Prior Authorization Integration Faces Implementation Barriers

by Hannah Nelson

Misfiring issues and provider education are keeping electronic prior authorization EHR integrations from achieving success, according to a study published in JAMIA. Time-consuming prior authorization...

Premier Nudges CMS to Boost Patient Data Exchange, Interoperability

by Hannah Nelson

CMS should establish cross-continuum data standards, automate the prior authorization process, and integrate administrative and clinical data to advance interoperability and improve patient data...

CMS Proposes Rule to Streamline Prior Authorization, Data Exchange

by Christopher Jason

The Centers for Medicare & Medicaid Services (CMS) proposed a new rule aiming to boost patient data exchange and streamline prior authorization to alleviate clinician burden. Additionally, the...

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