Don Rucker on HIT Consultant: Prior Authorization and Interoperability – Changing the Dynamics of Medicare

Medicare’s changing landscape, especially with Medicare Advantage (MA), prompts a reassessment of operational strategies. In the article, Don highlights the Centers for Medicare & Medicaid Services’ (CMS’) initiatives for the clinically appropriate allocation of care through the Interoperability and Prior Authorization final rule.

These rules focus on two main components:

API Implementation: Intensifying focus on APIs to improve data accessibility using modern internet protocols and standardized formats like FHIR®.

Modernizing Prior Authorization Processes: Aiming to simplify and modernize prior authorization procedures, including setting strict timelines, transparent reporting of denials, and a digital approval system for non-drug orders.

Despite their technical nature, these changes aim to enhance healthcare accessibility and effectiveness for all. Read more about these developments on HIT Consultant.