The public comment period just closed for the Centers for Medicare and Medicaid Services’ (CMS) proposed rule on “Advancing Interoperability and Improving Prior Authorization Processes.” And as of 11:59 PM March 13, the CMS had received close to 1,000 comments, including one from Myndshft. Below is a quick recap of our response. Want more details? Check out our Myndshft response to the CMS request for public comment in its entirety. Addressing prior authorization crucial for value-based care success Rampant process inefficiencies slow progress toward value-based care. Today’s manual prior authorization process is time-intensive and costly, and that won’t change without… Read entire article here
March 6, 2023
Full Steam Ahead: Regulations Create Momentum for Streamlined Healthcare Data Exchange & Prior Authorization Automation
by Susan Lawson-Dawson | News
Remember the classic tale of The Little Engine that Could? Moving forward on healthcare interoperability has felt like chugging uphill slowly, but as existing and new regulations come into force, momentum will shift. What can you expect to see? Improved data exchange between providers and payers, enabling streamlined processes like prior authorization automation. Mapping the regulatory path to interoperability This journey officially began back in 1996, when the Health Insurance Portability and Accountability Act—or HIPAA—set national standards for electronic health transactions and code sets, as well as privacy and security rules for protected health information. In 2003, the Medicare Prescription… Read entire article here
January 3, 2023
How Volunteer Attorneys Are Helping Patients Overcome the “Financial Toxicity” of a Cancer Diagnosis
by Susan Lawson-Dawson | News
Recently, we spoke with Senior Staff Attorney Erin Hartung about her work with Cancer Legal Care in Minnesota. Established in 2007, Cancer Legal Care staff, along with a network of volunteer attorneys, have helped over 12,000 Minnesotans with legal issues stemming from their cancer diagnosis and treatment. As the manager of the ICARE Program (Insurance Claim Advocacy and Resolution) at Cancer Legal Care, Erin is all too familiar with the challenges that cancer patients encounter from prior authorization delays and claim denials. ICARE focuses on helping with: Health insurance plan and coverage questions, claim denial appeals, and claim management Short-term… Read entire article here
December 1, 2022
Why Prior Authorization Software Is the Revenue Stream Multiplier You Want
by Susan Lawson-Dawson | News
As a Software as a Service (SaaS) provider, you’re probably quite familiar with the Rule of 40. As McKinsey & Company explains, the Rule of 40—that a company’s growth rate plus free cash flow rate should equal 40% or more—is a “... favorite of SaaS industry watchers, including boards and management teams, because it neatly distills a company’s operating performance into one number.” Unfortunately, McKinsey research also suggests that only 33 percent of SaaS organizations hit that mark and even fewer sustain it long term. Exceeding the 40% mark is even more rare, with only 16% going above and beyond.… Read entire article here
