CMS reinforced ongoing electronic prior authorization implementation efforts across the healthcare industry, highlighting interoperability coordination, payer workflow modernization, and key operational deadlines extending through 2027.
Early hospital data tied to CMS’ WISeR Model suggests AI-driven prior authorization in Medicare may be extending approval timelines and delaying patient care.
CMS will host an April 16 webinar to review the CMS-0062-P proposed rule, outlining drug prior authorization updates, interoperability standards, and expected impacts.
prior authorization
Health plans report an 11% drop in prior authorization volume as of April 7, 2026, following reform efforts, with continued focus on electronic processing and industry standardization.
CMS has delayed prior authorization requirements under the WISeR model for select radiology procedures following industry pushback, citing operational readiness concerns and ongoing AI-related scrutiny.
CMS proposes a new hospice scoring system and transparency measures in the FY 2027 rule to flag high-risk providers and strengthen oversight of Medicare hospice care.
CMS finalized a new rule requiring electronic claims attachments, with compliance required by May 2028 and significant projected cost savings.
CMS now requires payers to publicly report prior authorization denial rates, turnaround times, and appeal outcomes, with first reports due March 31.
HHS and CMS announce a new Healthcare Advisory Committee to guide policy, improve patient care, and modernize healthcare delivery across federal programs.
