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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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.
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.
Federal deregulation is narrowing AI transparency rules in certified health IT. It doesn’t remove the need to show how an AI-influenced decision was made. What certification, accreditation, and payer contracts actually require in 2026.
SNF admissions leaders make referral decisions in minutes, on an incomplete financial picture, while Medicaid — their primary payer — keeps getting squeezed. Here’s why that’s an architecture problem, not a training problem, and what it would take to fix it without asking facilities to spend money they don’t have. Table of contents The twenty-minute […]
Short answer: CMS-0057-F requires health plans to launch a Prior Authorization API by January 1, 2027. As of WEDI’s most recent survey, a large share of payers are still early in that build, even as many announce broader prior-auth reform. For hospitals — especially rural and critical access hospitals in the Pacific Northwest running on […]