On Sept. 17, the Centers for Medicare & Medicaid Services (CMS) announced that it’s delaying an interoperability rule governing how payors are expected to exchange with one another. However, the … [Read more...]
Interoperability
CMS Delays Payer-to-Payer Data Exchange but Prior Authorization Rules Remain on Track
September 23, 2021
Reproductive Testing
Don’t Rely on Biomarker Tests to Predict Risk of Premature Births, Warns AACC
July 1, 2021
After steadily declining, the rate of spontaneous preterm births in the U.S. rose to 10 percent in 2018. Preventing premature births would save the nation over $26 billion per year. However, … [Read more...]
Utilization Management
Congress Moves to Limit Prior Authorization Protocols of Medicare Advantage Plans
May 19, 2021
Prior authorization has been a perennial source of friction between payors and providers. While payors have a legitimate need to ensure program integrity and manage utilization of covered health … [Read more...]
Utilization Management
New Federal Regulations Streamline and Speed Up Payor Prior Authorization
January 30, 2021
In its final days, the Trump administration finalized (and, in the eyes of many in the health care industry, rushed) regulatory changes designed to ease prior authorization rules and improve provider … [Read more...]
Utilization Management
CMS Proposes New Regulations to Streamline and Speed Up Payor Prior Authorization
January 4, 2021
As its days dwindle down, the Trump administration proposed regulatory changes designed to ease prior authorization rules and improve provider and patient access to medical records. Specifically, the … [Read more...]
Data
Genomic Testing Utilization Is Low & Geographically Inconsistent but Not Just Due to Payor Coverage
October 8, 2020
Genomic testing is inconsistently utilized in the U.S., even in states with favorable coverage policies. Those are the findings of a report from the Personalized Medicine Coalition (PMC) released in … [Read more...]
Test Utilization
Rapid Testing the Linchpin of COVID-19 Contact Tracing Effectiveness
July 27, 2020
Without rapid testing and results, COVID-19 contact tracing will not work. That is the conclusion of a new study published in The Lancet. Even the most efficient contact tracing strategy will not … [Read more...]
ACMG the Latest to Come Out Against Genetic Testing for All Breast Cancer Patients
January 19, 2020
The debate over the need for genetic testing of all breast cancer patients for germline pathogenic or likely pathogenic variants in BRCA1, BRCA2 and other breast cancer-linked genes continues with the … [Read more...]
UTILIZATION MANAGEMENT
Utilization: Study Finds that Distribution of Free Self-Tests Increases HIV Testing & Awareness
January 3, 2020
Internet distribution of free HIV self-tests can boost testing, promote awareness among high-risk individuals resulting in less incidence of transmitting the disease. These are the key findings of a … [Read more...]
TEST UTILIZATION
Test Utilization: ‘Cascades of Care’ Cause Wasteful, Unnecessary and Anxiety-Producing Testing
November 16, 2019
Experts estimate that $200 billion is wasted annually on excessive testing and treatment. The typical dynamic is a chain reaction: Something “comes up” on diagnostic tests or screenings and triggers … [Read more...]
