Track the CMS Interoperability and Prior Authorization API final rule (CMS-0057-F) — the Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs payers must stand up — with every deadline linked to its primary source.
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Settlement resolves allegations that Florida-based primary care network inflated Medicare Advantage risk scores through improper diagnosis submission. The Villages Health System has agreed to pay $541.5 million to settle allegations that it submitted false diagnosis codes to the government to...
The AMA supports CMS's revised guidance addressing payer compliance with prior authorization transparency requirements under the 2024 Interoperability and Prior Authorization final rule. The American Medical Association (AMA) has publicly endorsed updated guidance from the Centers for Medicare &...
The ONC's refreshed TEFCA fact sheet shows Qualified Health Information Networks now connect over 150 million unique patients and 1.8 million clinicians, underscoring rapid national scaled exchange under the Trusted Exchange Framework. The Office of the National Coordinator for Health IT (ONC)...
A study found four mandatory CMS VBC programs generated substantially higher administrative expenses compared to non-participating hospitals. Researchers analyzing Medicare cost reports determined that four mandatory value-based payment programs administered by CMS were associated with more than...
The investigation examines whether Epic's health IT dominance and data-sharing policies violate antitrust laws, with potential implications for interoperability and EHR market competition. The U.S.
HRSA is proceeding with the 340B Rebate Model Pilot Program starting January 1, targeting 25 potentially eligible drugs despite covered entities' concerns about administrative burden. The Health Resources & Services Administration (HRSA) is advancing its revised 340B Rebate Model Pilot Program,...
CMS locks in inpatient hospital payment update at 2.3%, below earlier proposal but projecting hundreds of millions in higher hospital payments from rule changes. The Centers for Medicare & Medicaid Services (CMS) has finalized the Inpatient Prospective Payment System (IPPS) rule, establishing a...
Despite reports of delays, HHS confirms it is proceeding with a final rule that would bar providers offering pediatric gender-affirming care from receiving Medicare and Medicaid reimbursement. HHS rebuked a recent report claiming that a controversial proposal to add pediatric gender-affirming...
The health plans allege CMS' methodology unfairly penalizes MA plans, potentially affecting reimbursement and plan competitiveness in the 2026 star ratings cycle. SCAN Health Plan and Alignment Healthcare have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) alongside...
By embedding structured clinical terminology directly into CPT codes, AMA aims to accelerate electronic prior authorization and cut administrative burden at the point of care. The American Medical Association has launched a new interoperability initiative focused on mapping structured clinical...
The Trusted Exchange Framework and Common Agreement has crossed a major adoption threshold, signaling that the national interoperability network is moving from pilot to production scale. The Office of the National Coordinator for Health Information Technology (ONC) has announced that TEFCA — the...
The Senate's vote to preserve WISeR clears a key political hurdle for CMS's first AI-driven prior authorization model in fee-for-service Medicare. Democratic lawmakers in both the Senate and House introduced Congressional Review Act-style resolutions in May seeking to overturn the CMS WISeR...
HHS/ONC's fifth Health Data, Technology, and Interoperability rulemaking targets certification program efficiency and continued information-blocking enforcement improvements. HHS and ONC have proposed the HTI-5 rule, the latest in the Health Data, Technology, and Interoperability rulemaking...
CMS's official FAQ spells out exactly what payers must do under CMS-0057-F — from 72-hour urgent decision windows to the nine public metrics due on websites by March 31, 2026. CMS has published a detailed FAQ on the Prior Authorization API requirements established in the 2024 CMS Interoperability...
New federal oversight measures — including third-party audits of TEFCA participants — signal ONC is shifting from network-building to network-accountability mode. ONC has announced a package of oversight measures designed to strengthen governance of the Trusted Exchange Framework and Common...
With HTI-4 finalized on August 4, 2025, ONC has now closed out four major rulemakings that together reshape certification criteria, information blocking, TEFCA, and prescription workflows. ONC's certification program regulations page now reflects a completed four-rule cycle stretching from early...
Medicare Advantage, Medicaid, CHIP, and Marketplace payers must deploy four new FHIR APIs and compress prior authorization timelines by 2026–2027, reshaping payer-provider-patient data exchange across the industry. CMS has finalized the Interoperability and Prior Authorization rule (CMS-0057-F),...
ONC's certification framework — the gatekeeper for federally recognized health IT — is updating criteria, surveillance rules, and standards versioning processes that every EHR and API developer must track. The ONC Health IT Certification Program is the federal mechanism through which health...
As CMS's LEAD model extends value-based care timelines, health systems that lack real-time post-acute data will find themselves structurally disadvantaged on cost and quality performance. CMS's LEAD (Longitudinal Episode-based Alternative Payment) model reshapes how accountable care organizations...
The 2024 CMS Interoperability and Prior Authorization final rule sets hard compliance deadlines for payers to implement FHIR APIs that streamline prior authorization and cross-payer data exchange — with a key HIPAA carve-out clearing the path. CMS released the 2024 Interoperability and Prior...
New conflict-of-interest protections and updated performance-review requirements will reshape how the nine CMS-recognized accrediting organizations survey more than 9,000 Medicare-participating providers. CMS has issued a final rule updating the regulatory framework governing the organizations...
The scale of non-compliance enforcement is larger than previously disclosed, signaling CMS is actively using its price transparency authority against a broad swath of providers. At least 519 hospitals across the country have received either a warning notice or a Corrective Action Plan (CAP)...
The agency is formalizing its ambitions in health-IT modernization by creating a dedicated organizational unit to lead interoperability initiatives and digital product development. The Centers for Medicare & Medicaid Services (CMS) has established a new health technology office designed to...
States must submit progress reports for the $50B Rural Health Transformation Program to HHS but face no federal requirement to make them publicly available, limiting transparency. The $50 billion Rural Health Transformation Program, administered by the Department of Health and Human Services...
The move from hybrid to electronic clinical data systems reporting aims to streamline data exchange and align with industry digital quality measurement trends. NCQA is transitioning the HEDIS® Transitions of Care (TRC) measure from its current hybrid reporting methodology to a fully electronic...
Panelists from state HIEs shared how health information exchange networks are being used to support social determinants of health screening and referral workflows, informing future innovation. During a Civitas Networks for Health event, an expert panel examined how states are utilizing Health...
Federal Medicaid funding for refugees, asylees, and humanitarian parolees ends October 1, 2026, posing financial risk to hospitals serving these populations. The article warns that H.R.
New system of records will collect PII to administer nursing workforce incentives for Medicare and Medicaid-certified nursing homes. The Centers for Medicare & Medicaid Services (CMS) is establishing a new system of records under the Privacy Act of 1974 to support the Nurses for Nursing Homes...
KFF analysis reveals significant variation in insurer denial rates and transparency gaps for prior authorization requests issued in 2025. KFF found that health insurers denied 12% to 18% of standard prior authorization requests in 2025, with notable variation across different insurers.
Limited research and evidence barriers make securing coverage difficult for women's health innovations, requiring early reimbursement planning. A new Milken Institute report cited by MedCity News explains that women's health startups face significant reimbursement challenges due to limited...
Voting is open through September 14, 2026, for the HL7 ballot cycle covering FHIR implementation guides and other consensus standards. HL7 International opened its September 2026 consensus ballot cycle on August 14, 2026, inviting ballot pool members to vote on proposed FHIR implementation guides...
CMS seeks public comment on a new pathway to expedite Medicare national coverage determinations for innovative medical devices using existing regulatory processes. The Centers for Medicare & Medicaid Services (CMS) has announced a proposed Regulatory Alignment for Predictable and Immediate Device...
HHS seeks to streamline health forms for unaccompanied alien children while adding provisions for limited health information sharing with DHS to ensure continuity of care. The Administration for Children and Families (ACF) Office of Refugee Resettlement (ORR) is proposing to restructure its...
CMS seeks public comment on renewed data matching to verify ACA minimum essential coverage eligibility via Department of War health benefits. The Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) has issued a notice in the Federal Register regarding the...
The final rule updates Medicare hospital payment rates for FY 2027, adopts new health IT standards, and modifies quality reporting requirements for acute care and long-term care hospitals. The Centers for Medicare & Medicaid Services (CMS) has issued a final rule revising the Medicare hospital...
HRSA announces a pilot implementing rebates instead of upfront discounts to achieve 340B ceiling prices, building on stakeholder input from prior RFI. The Health Resources and Services Administration (HRSA) has announced the availability of a revised 340B Rebate Model Pilot Program, implementing...
Rule updates hospice wage index, payment rates, and quality measures while finalizing hospice election statement addendum requirement for all Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) has issued a final rule updating the hospice wage index, payment rates, and...
Updates Medicare payment rates for inpatient rehabilitation facilities, phases out the rural adjustment, and revises quality reporting and admission timing requirements for FY 2027. This final rule from the Centers for Medicare & Medicaid Services (CMS) updates the prospective payment rates for...
The new HL7 FHIR Implementation Guide enables scalable, interoperable consent management across healthcare data exchange networks. The HL7 FHIR at Scale Taskforce (FAST) has released the Scalable Consent Management Implementation Guide to address growing challenges in consent enforcement across...
The rule sets payment rates for skilled nursing facilities in FY 2027 while refining quality measure requirements under both the SNF QRP and VBP programs. CMS has issued a final rule updating the Skilled Nursing Facility Prospective Payment System (PPS) and consolidated billing policies for...
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