Track the CMS Interoperability and Prior Authorization API requirements — 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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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...
Indiana's Republican governor is backing direct price controls on hospitals — a rare and politically significant move that could become a model for other states frustrated by runaway healthcare costs. Indiana has moved to cap the prices hospitals can charge employers, marking an unusually...
A leading health system's real-world AI rollout in billing and claims comes with an internal reality check from the executive overseeing it. Mayo Clinic is actively integrating artificial intelligence into its revenue cycle operations, spanning functions such as billing, claims processing, and...
Repeal efforts are underway, but experts aren't convinced Democrats have the votes or leverage to undo the controversial payment model. Congressional Democrats are seeking to repeal the WISeR (Work Incentives Support and Engagement in Recovery) model, a CMS payment initiative that has drawn...
A MedCity News analysis argues that current MA program adjustments are reshaping what the next phase rewards — with outsized implications for smaller and regional plans. A June 2026 MedCity News commentary by Deepti Loharikar and Daniel Fellenbaum frames the Medicare Advantage (MA) program as...
Blue Cross Blue Shield Association's approach to centralizing and digitizing reference medical policies into reusable FHIR Questionnaires offers a concrete playbook for payers and vendors scaling prior authorization under Da Vinci DTR. The HL7 Da Vinci Project's June 2026 Community Roundtable...
A new designated expert role for information blocking enforcement has arrived with no clear definition of qualifications, scope, or process — including from the expert themselves. ONC has established a formal "Information Blocking Expert" designation under the information blocking framework, but...
A new integrative review maps the legal, technical, and governance barriers to deploying granular, revocable patient consent for secondary health data use across Europe — and proposes a three-stage architecture to address them. Secondary use of health data — for research, innovation, and public...
A new CMS organizational unit consolidates the agency's health-IT standards agenda under a chief product officer, ending the fragmented command structure that long complicated interoperability policy execution. CMS has established the Office of Health Technology and Products (OHTP) , a structural...
DirectTrust's submission signals the health-IT trust community's stake in how CMS shapes FHIR-based prior authorization and interoperability standards for drugs. DirectTrust submitted formal comments to HHS and CMS on the Interoperability Standards and Prior Authorization for Drugs Proposed Rule...
New statutory restrictions on Medicaid state directed payments—paired with a CMS proposed rule—could reshape how hospitals and other providers are reimbursed under managed care, with an estimated $911 billion in federal Medicaid spending reductions over a decade. The 2025 reconciliation law...
As AI systems consume clinical data across organizations, syntactic interoperability alone fails to preserve meaning — a shared semantic layer is now a prerequisite, not a nice-to-have. In a MedCity News opinion piece, Hamid Tabatabaie argues that the healthcare industry's hard-won...
CMS's proposed rule would restructure how states can direct supplemental payments to Medicaid managed care providers and cap certain fee-for-service targeted payments, with broad implications for hospital and provider payment strategies. The Centers for Medicare & Medicaid Services (CMS)...
Fully-sourced weekly briefs, tracked from proposal to final.
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