HealthAxis Group’s Post

! BIG news from CMS today ! The agency has issued the long awaited final rule to further modernize our health care system and to reduce patient and provider burden by streamlining the prior authorization process. While prior authorization can help ensure medical care is necessary and appropriate, it can sometimes be an obstacle to necessary patient care when providers must navigate complex and widely varying payer requirements or face long waits for prior authorization decisions. This final rule establishes requirements for certain payers to streamline the prior authorization process. Beginning primarily in 2026, impacted payers will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half. The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed. They will be required to publicly report prior authorization metrics, similar to the metrics Medicare FFS already makes available. Finally, and most exciting for a company like Repisodic, The rule also requires impacted payers to implement a Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Prior Authorization application programming interface (API), which can be used to facilitate a more efficient electronic prior authorization process between providers and payers by automating the end-to-end prior authorization process. Together, these new requirements for the prior authorization process will reduce administrative burden on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients, and prevent avoidable delays in care for patients. #cms #priorauthorization #healthcareinnovation #hl7 #fhir #api #insurance #medicare #medicaid https://lnkd.in/e6VuyPra

🏥 Navigating the Complex World of Healthcare IT Regulations 📊 Healthcare is undoubtedly one of the most heavily regulated industries in the U.S., and the ever-evolving landscape of regulations can be a minefield for providers. Non-compliance can come at a hefty cost, not only financially but also in terms of patient care. At Ingenuity Group, we take pride in being good stewards of our clients' budgets while helping them navigate this dynamic regulatory environment. Our team of IT service management experts is committed to staying ahead of the curve, ensuring that our clients comply with federal, state, and local legislative bodies' mandates affecting the delivery of healthcare IT services. 🔍 Price Transparency: Meeting the CMS Mandate 📈 One of the most pressing challenges in healthcare today is the need for transparency in pricing. The Center for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), has mandated the Price Transparency final rule, and compliance is non-negotiable. Ingenuity Group advisors are here to assist you in leveraging your existing IT systems and data to meet these requirements effectively. We believe that patients deserve real-time, personalized access to pricing information across all payers and plans, and we are dedicated to making this accessible in a user-friendly and secure manner for both patients and healthcare providers. At Ingenuity Group, we don't just navigate regulations; we excel in it. Let us partner with you to ensure compliance, improve patient satisfaction, and help you provide the best healthcare services possible while being mindful of your budget. #HealthcareIT #Regulations #PriceTransparency #Compliance #IngenuityGroup #HealthcareTechnology #StewardsOfBudgets

🚀 Industry Insight: CMS Rule Streamlines Prior Authorizations – Boosting Efficiency The recent CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is a game-changer for healthcare providers. By addressing patient care delays and streamlining processes, it promises to save physician practices an estimated $15 billion over the next decade. This rule impacts a wide spectrum of healthcare programs, including Medicare Advantage, State Medicaid, CHIP, fee-for-service, and managed-care plans. Starting in 2026, payers will be required to expedite prior authorization decisions, responding within 72 hours for urgent requests and seven calendar days for non-urgent ones. As a true AI-first prior authorization solution, we’re uniquely positioned to empower payers, providers and their business partners with efficient, accurate prior authorizations, reducing administrative burdens and ensuring timely patient care. 🌟 How Ethermed Can Help Ethermed anticipates the operational shift prompted by regulatory change. Our AI-driven platform automates the prior authorization process, integrating effortlessly into your existing workflows. The result? Manual tasks reduced by up to 90% and assured compliance with evolving CMS regulations. Healthcare providers and utilization management teams can refocus energy on delivering quality care instead of administrative overload. 🤝 Ready to optimize your prior authorization? Connect with us to see how Ethermed can support your goals. #HealthcareInnovation #PriorAuthorization #CMS2024 #MedicareAdvantage #HealthTech #DigitalHealth

Interoperability in healthcare isn't just a 🌟 buzzword 🌟 —it's the key to unlocking seamless communication between different systems and providers. When data flows freely across platforms, patients benefit from more coordinated care and better outcomes. Let's champion interoperability to ensure that every patient's journey is smooth and supported by a connected healthcare ecosystem. #DataExchange #HealthcareInteroperability #ConnectedCare #HealthIT #EHRInteroperability #CMS 🏥 Learn more:

Innovation or Obsolescence: Which Path Is Your Operations On? The healthcare landscape is rapidly changing, challenging payers and TPAs to innovate or risk falling behind. At HealthAxis, we offer transformative strategic consulting services designed to turn these challenges into triumphs. 🚀 📊 Core System Optimization: Say goodbye to inefficiencies with our expert system design, configuration, and data management solutions. 📞 Contact Center Augmentation: Elevate your service levels with our comprehensive training programs and telephony audits, creating unmatched customer interactions. 📜 Compliance Adherence: Navigate the complex regulatory landscape effortlessly with our tailored training and workflow assessments. Partner with us to transform your operations and set new benchmarks in the healthcare industry. With HealthAxis, it's not just about overcoming challenges; it's about setting a new standard of excellence. Learn more and connect with our experts 👉 https://lnkd.in/dHRz2rww #HealthAxis #ClaimsProcessing #ClaimsManagement #HealthcarePayers #HealthcareConsulting #Consulting #Medicaid #Medicare #MedicareAdvantage #HealthcareInnovation #HealthcareSolutions #PayerSolutions #ManagedCare #HealthcareAdministration #ProviderRelations #HealthcareManagement #HealthInsurance #TPA #ThirdPartyAdministrators #ValueBasedCare #HealthcarePayers #InsuranceClaims #Compliance #CMS #ComplianceAdherence

Prior authorization has long been a significant pain point for healthcare providers and patients. Discover how CMS's Final Rule intends to simplify the revenue cycle, and find out how maxRTE's Prior Authorization solution can help providers gain the advantages of this Rule before it becomes mandatory in 2026. #priorauthorization #rcm https://lnkd.in/eTMhfb8h

The healthcare industry faces challenges in payment collection due to a technology gap between payers and providers. This disconnect leads to high rates of litigation, claim appeals, and underpriced claims. At REVELOHEALTH, we address this issue by aligning provider contracts with payer pricing technology to ensure contract integrity. Our CALIBRATE™ solution recently improved inpatient claim payments, reducing the need for appeals and uncovering significant underpriced claims, with Medicare Advantage claims being a notable area of focus. #healthcare #paymentcollection #technologyintegration Here are some consistent facts from a recent integration. (1.) Over 17.5% of inpatient claims are priced within 95% of the contracted rate. Less than 62.2% are paid within 1% of the contracted rate. Imagine if we had 95% of claims were priced within 1% of the contracted rate? (2) A single payer accounted for over $3.2MM of underpriced claims with an average of over $1,500 per claim. A provider will have to incur the additional claim appeal cost to collect this owed amount. (3) Medicare Advantage plans account for over 72% of the underpriced claims. (4) Simple E&M office visit codes are the primary source of underpriced physician claims. There is a better way than continuing to take the same historical actions. By using the same payer technology, a provider can determine the allowable for each episode of care immediately before incurring the high cost of traditional revenue cycle management. Is it about time we change our thinking about the cost of collection for healthcare payments?

The disconnect between payers and providers in healthcare leads to costly claim appeals and underpriced claims. At REVELOHEALTH, we’re closing this gap with our CALIBRATE™ solution. Check out how we’re transforming payment collection in healthcare! #healthcare #paymentcollection #technologyintegration Read more from our CEO’s latest post:

Albany Medical Center’s recent adoption of the Epic EHR system marks significant advancement, with other facilities within the Albany Med network preparing for the transition later this year. This includes Columbia Memorial Health - Hudson, NY, Glens Falls Hospital, and Saratoga Hospital. Changing EHR vendors poses challenges, from cost and disruption to potential revenue leakage. In fact, we find that the average net patient revenue loss is 1-3.5% in the first year post-conversion. Discover how our EHR System Conversion Revenue Leakage Insurance protects your revenue during transitions. With a 4x ROI Guarantee and SMaRT Analytics, we ensure a smoother transition—download our White Paper today 👇 #EpicSystems #HealthcareTechnology #EHRImplementation

Exciting news, folks! 🎉 My latest blog post delves into the transformative CMS Interoperability and Prior Authorization Final Rule that's set to revolutionize healthcare. 🏥✨ We're talking new APIs for better patient access, smoother provider collaboration, and faster prior authorizations. These changes are huge for everyone in the Medicare Advantage, Medicaid, and CHIP spheres! Curious about what this means for you and how to get ready for the 2027 compliance deadlines? I've broken it all down. Check it out and stay ahead in the healthcare game! 🚀 #HealthcareInnovation #CMS #Interoperability #FinalRule 👉 https://bit.ly/48KU1WZ