What You Should Know:
The Biden-Harris Administration has finalized a new rule that streamlines the prior authorization process and improves health data exchange across the healthcare system. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) represents a significant step towards reducing bureaucratic burdens, accelerating access to care, and fostering a more patient-centered healthcare experience.
Streamlining Prior Authorization
The rule tackles the often
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Prior Authorization
RCM: Why Generative AI is Needed for Prior Authorization Reform
The headline-grabbing emergence of generative AI platforms, such as ChatGPT, BARD and BingGPT, has forced leaders across all verticals to ask, “What can we optimize with AI?” The AI chatbots remain in early stages of their development, but they have shown enough promise to suggest their full arrival is imminent. Every industry is currently weighing the best way to deploy AI, and that includes healthcare, where efficiency and improved workflows can make a tangible impact on the care that patients
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6 Ways Health Payors Can Leverage Intelligent Document Processing for Cost Savings
The prevailing global economic conditions are negatively impacting the healthcare industry. Continuing staff shortages, endemic COVID-19, high inflation rates, and supply chain disruptions continue to drive medical costs higher, worsening what is already a persistent challenge for health insurers.
To offset rising healthcare costs, health insurance payors are challenged to find ways to contain their own costs by streamlining their processes and tightening their belts, which invariably
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Report: Prior Authorization for Biomarker Testing Leads to Treatment Delays For Cancer Patients
What You Should Know:
Biomarker testing is a necessary tool in the advancing world of precision cancer treatment. According to a new survey released by CancerCare, a leading national cancer support organization, biomarker testing helped doctors tailor therapy for nearly all the respondent patients (93%) whose cancers were tested over the past three years. Two in 10 cancer patients (20%) surveyed were able to avoid unnecessary chemotherapy and/or radiation and 10% became eligible for
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Salesforce Launches New Customer 360 for Health Capabilities to Deliver More Personalized Patient Experiences
What You Should Know:
- Salesforce today announced new Customer 360 for Health capabilities that help healthcare providers deliver more personalized patient experiences and reduce operational costs.
- Customer 360 for Health helps healthcare and life sciences organizations enhance the overall care experience with the full power of Salesforce technology, including real-time data from Data Cloud, Einstein AI, and automation with Flow.
New Customer for
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How Search Makes Clinical Natural Language Processing Useful in the Real World
Clinical Natural Language Understanding (cNLU), the technology by which computers extract meaning from clinical text, is quickly becoming a common feature in the healthcare IT landscape. In 2021, 30% of surveyed healthcare organizations were either using or exploring the technology. (Gradient Flow, 2021). Similar adoption is occurring in the UK as well. (Wu et. al, Nature, 2022). Today, cNLU is being applied to billing/coding, trial enrollment, registry creation, clinical decision support,
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17 Execs Share How Health IT Can Address Clinician Burnout, Staffing, & Capacity
Clinician shortage has reached a new level of urgency as we face rising demand and healthcare costs, according to a recent Accenture report. Healthcare workers are increasingly burned out and leaving the industry altogether in droves. Those who remain to do the work are overburdened. We ask seventeen healthcare IT executives for their insights on how health IT solutions could potentially help address clinician burnout, clinician staffing shortages, and deal with capacity.
Staffing levels
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A New Way of Thinking About Interoperability in 2023
Interoperability in the U.S. healthcare system has been an ongoing challenge. While there are several industry initiatives that are going to advance the industry and make incremental progress toward interoperability, there remain several gaps that are unaddressed.
Interoperability is a much broader concept that encompasses more than protocols, APIs, and limited networks. It’s about more than exchanging data through one-to-one connections between a provider, payer, or vendor. True
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AGS Acquires Offshore Patient Access BPO Unit from Availity
What You Should Know:
- AGS Health, a provider for tech-enabled revenue cycle management (RCM) solutions announces the acquisition of the India-based patient access outsourcing business unit of the Florida-based healthcare technology company Availity.
- With more than half of U.S. hospitals anticipating a year of negative margins, achieving full and accurate reimbursement for services has never been more critical. With this expansion, AGS Health is positioned to provide faster, more
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KLAS: What Impact Do Automated Prior Authorization Solutions Provide?
What You Should Know:
- Prior authorization is mandated by payers to ensure that certain clinical procedures and medications being ordered are necessary. To alleviate the heavy administrative burden this requirement causes, healthcare organizations have adopted automated prior authorization solutions.
- For this report, KLAS interviewed 30 respondents from 26 unique organizations to understand their experiences using these solutions and what outcomes they have seen.
Understanding
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