Reducing Provider and Patient Burden Proposals in a nutshell

The Interoperability and Patient Access Final Rule was no doubt, a stepping stone towards quick and easy healthcare information exchange. The proposal in discusses here is aimed at perfecting what was created in the IPA, while also outlining new requirements that may need to be implemented.

Building upon IPA, the proposal focuses on ensuring improved healthcare information exchange to facilitate relevant access to complete health records for patients, providers, and Health Plans by ensuring the mandatory implementation of specific IGs. While doing so, CMS is equally focused on reducing burden on the patient and provider, in making care decisions.

The Imperative IGs

In this proposal, to avoid further misalignment and fracture of health records, the CMS is mandating the payers to use specific IGs for the implementation of FHIR-based APIs.

Reducing the Burden of Prior Authorization

The proposal suggests payers to implement and maintain an FHIR-based Document Requirement Lookup Service (DRLS) and Prior-authorization Support (PAS) API for smoother electronic data exchange.

Request For Information

The CMS requests input on navigating data segmentation, behavioral health information, improving prior authorization, reducing use of fax machines and the adoption of standards related to social risk.

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