CMS Pre-Authorizations – November 2024

CMS Pre-Authorizations – November 2024

CMS Interoperability and Prior Authorization Final Rule SynopsisThe Centers for Medicare & Medicaid Services (CMS) changed its prior authorization rules to simplify and digitize the process, and to reduce the burden on each of the three legs in the healthcare...
Precision Medicine – Part 1 – September 2024

Precision Medicine – Part 1 – September 2024

Precision Medicine as key driver of next generation personalized health care The term “Precision Medicine” refers to the tailoring of clinical and other health care-related interventions based upon an individual’s unique make-up and circumstances. While...
Payment Integrity 101 – Article 3 – June 2024

Payment Integrity 101 – Article 3 – June 2024

Payment Integrity Evolution Over the past decade, the healthcare industry has seen payment integrity evolve from an under-resourced operational niche to a strategic asset that is central to the overall management of medical expense. A paradigm shift is underway,...
Payment Integrity 101 – Article 2 – June 2024

Payment Integrity 101 – Article 2 – June 2024

Guiding Principles: Payment Integrity as a Strategic Enterprise Solution Today’s technology innovations and workforce challenges (need to drive toward greater efficiency) are prompting payers to take a closer look at payment integrity with an eye toward a more...
Payment Integrity 101 – Article 1 – May 2024

Payment Integrity 101 – Article 1 – May 2024

Current State of Healthcare Payment Integrity: Article 1 Understanding what healthcare payment integrity entails and why there is renewed interest Payment integrity encompasses efforts on the part of payers and healthcare providers alike to navigate ongoing challenges...