CMS’s CY 2027 outpatient proposal signals new scrutiny on site-of-care costs, utilization management, 340B drug payments, ASC migration, and hospital pricing data.
Federal hospital price transparency enforcement is accelerating as more than 500 hospitals receive warnings or corrective-action requests, raising strategic implications for payers, employers, and healthcare cost transparency.
CMS finalized significant reforms to the Federal Independent Dispute Resolution process, lowering fees, improving transparency, and introducing operational changes for payer-provider payment disputes.
Congressional lawmakers introduced resolutions seeking to overturn CMS’ WISeR AI-assisted prior authorization pilot following a GAO determination that the Medicare model should have undergone congressional review prior to implementation.
CMS announced a growing group of payers, health systems, EHR vendors, and interoperability organizations participating in its Electronic Prior Authorization Acceleration initiative ahead of 2027 interoperability and electronic prior authorization requirements.
CMS announced a nationwide six-month enrollment moratorium for hospice and home health agencies, signaling expanded utilization oversight, fraud prevention efforts, and increased scrutiny of prior authorization, claims review, and post-acute care management practices across the payer industry.
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.
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