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.

Share with your community

Sign up to get the latest insights and updates from 1upHealth