In Depth Healthcare Data Analysis | Health Industry Consultants

In Depth Analysis

Featured Insights


Impact of Site Neutral Payment Proposals May Vary in Rural and Urban Populations
February 29, 2024

This +Insight focuses on how site-of-service patterns for drug administration services differ for Medicare beneficiaries based on where they live.



Potential Election Year Shakeup: Regulatory Implications of the Congressional Review Act
February 28, 2024

This article explores the Congressional Review Act (CRA) and how it might impact the current administration’s regulatory agenda.



Site Neutral Payment Policies for Ambulatory Services
February 15, 2024

Our analysis of proposed site neutral payments for ambulatory services, which, if enacted, would have a meaningful impact on healthcare providers’ finances.



CMS Approves New York 1115 Medicaid Redesign Waiver
February 1, 2024

On January 9, 2024, the Centers for Medicare and Medicaid Services (CMS) approved the New York State (NY) 1115 Medicaid waiver “Medicaid Redesign Team” (MRT). The MRT is a long-standing waiver in NY that has continuously evolved to improve the administration, structure and financing of the NY Medicaid program; enhance Medicaid beneficiaries’ access to services; and improve health outcomes across the state. The recently approved waiver represents the next step in Medicaid redesign in NY and builds on the previous Delivery System Reform Incentive Payment (DSRIP) program.



CMS Releases Advancing Interoperability and Improving Prior Authorization Processes Final Rule
January 25, 2024

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will require certain payers to automate their prior authorization processes and implement application program interfaces (APIs) to improve the exchange of health information among payers, providers and patients. The rule outlines these new requirements, exceptions to the requirements and implementation deadlines. It also adds a new electronic prior authorization measure that clinicians and hospitals must report as part of the Merit-based Incentive Payment System (MIPS) Promoting Interoperability Category and the Medicare Promoting Interoperability Program, respectively.

The final rule comes at a time when Congress has been active on prior authorization reform, including through legislation. This article compares the final rule with that legislation, highlights policies that are not included in the final rule and discusses next steps for prior authorization reform.