Starting in 2027, hospitals and CAHs must attest they requested at least one prior authorization electronically – regardless of whether their payers’ APIs are actually ready.
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A federal review of 19 Medicare Advantage organizations found they collectively denied 12% of skilled nursing facility admission requests — a rate that ranged from 0.4% to 23% depending on the organization. But averages hide the more useful finding here: one contractor processed half of every SNF request in that review, and denied them at […]
CHQPR’s July 2026 data puts roughly 700 rural hospitals at risk of closing, over 260 immediately. Denial management won’t reverse that. On a margin this thin, what it can still recover — and what it can’t.
A founder’s checklist for evaluating FHIR development partners — real integration experience, cloud delivery, compliance architecture, and what red flags mean you’re about to overpay for a rebuild.
EHR-native AI in skilled nursing can now flag authorization gaps before claims are submitted. But the workflow doesn’t end there. What happens when a payer issues a determination, ends coverage mid-stay, or forces an appeal?
In an HHS-OIG review of June 2024 data, Medicare Advantage plans overturned 95% of appealed SNF admission denials, while enrollees and providers appealed 18% of denials. What that gap means for post-acute appeal triage.