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CMS Prior Authorization Final Rule
Manage episode 413864213 series 2993668
On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.
Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.
You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com
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Manage episode 413864213 series 2993668
On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.
Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.
You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com
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