The CMS Interoperability and Prior Authorization Final Rule asks utilization management teams to do two things at once:
decide faster and stand behind those decisions at a higher level of accountability.

Those two goals sound compatible, but in the day to day they pull against each other. A shorter timeline still has to produce a decision that is clinically sound, clearly documented, and consistent enough to defend. That weight falls on teams already balancing volume and reviewer coverage.

Providers feel the same squeeze from the other side, in what they have to document and how quickly they have to submit it.
Moving faster while answering to a higher standard is no small adjustment for either group and both sides are working out how to get there.

Join the Discussion
BHM Healthcare Solutions is hosting an invitation only live discussion built around a single question related to this subject:
How do you move faster under CMS-0057-F without giving up clinical integrity, consistency, or defensibility?

Moderated by Jannis Paulk, with Mary McCormick, Vice President of Account Management at BHM Healthcare Solutions, and Dr. Qionna Tinney, MD, FAPA. They dig into where the pressure is really landing, how payer and provider communication is shifting, and where they are seeing signs of movement in their day to day work.

This is challenging work but the groundwork is being laid. Join us to see what it looks like.

Request access to attend live, or reserve the replay if you cannot make it.