Interoperability

CMS Delays Payer-to-Payer Data Exchange but Prior Authorization Rules Remain on Track

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...]

Reproductive Testing

Don’t Rely on Biomarker Tests to Predict Risk of Premature Births, Warns AACC

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

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

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

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

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

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

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

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

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...]


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