C4BH Round-Up: January 23, 2024

CMS Finalizes Interoperability and Prior Authorization Rule

A new final rule from the Centers for Medicare & Medicaid Services (CMS) aims to advance data exchange and prior authorizations among impacted payers, including Medicare Advantage organizations and Medicaid managed care plans.

Its provisions require the implementation of HL7 FHIR application programming interfaces (APIs) to support patient and provider access, payer-to-payer information sharing, and prior authorization approvals, plus timeline, denial explanations, and reporting metrics to improve prior authorization processes. (CMS Newsroom, 1/17)

Draft TEFCA 2.0 Materials Open for Public Feedback

Updated draft versions of the Common Agreement, Qualified Health Information Networks Technical Framework, plus more draft materials have been released by the recognized coordinating entity for the Trusted Exchange Framework and Common Agreement (TEFCA), a national initiative of the Office of the National Coordinator for Health Information Technology (ONC).

ONC is looking to support HL7 FHIR-based data exchange in the next version of TEFCA. Stakeholder feedback is due by 2/5. (Healthcare IT News, 1/22)

Research Reveals Low Documentation of SDOH with Z-Codes

Health care providers can use Z-codes in their coding processes to record patient information related to the social determinants of health (SDOH). However, two independent studies reveal extremely low use.

One identified that over 50% of hospitals use the Z-code for housing insecurity, but less than 10% use any other type of Z-code. Another supports this finding of low Z-code documentation, finding it 50% higher among Medicaid patients compared to those commercially insured, likely due to SDOH factors being more likely to impact their health. (Patient Engagement HIT, 12/21)

ONC Releases Draft USCDI v5 with New Data Classes and Elements

The United States Core Data for Interoperability (USCDI) standardizes data elements and sets the baseline for health information exchange nationwide. In Draft Version 5, ONC proposes two new data classes, including Observations and Orders, and thirteen new data elements, including Interpreter Needed and Emergency Department Note. (EHR Intelligence, 1/19)


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