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What Is Interoperability in Healthcare?

The ability of different systems, devices, and applications to work together and exchange information seamlessly is known as interoperability in healthcare. At its best, it would allow patients using multiple insurance plans (e.g., Medicare and a supplemental plan) to receive care from multiple providers (e.g., primary care physician, psychotherapist, physical therapist, pharmacist) who work in multiple healthcare systems. Interoperability is essential in healthcare because it allows providers to access and use relevant patient information from different sources, such as electronic health records (EHRs), lab results, psychological testing, and radiology images. Interoperability can help improve patient care by offering providers a more complete and up-to-date view of a patient’s health status and history. In this article, the recent proposal identified as “CMS-0057-P” by the Centers for Medicare and Medicaid Services (CMS) for the concept of interoperability will be applied to the prior authorization process.

CMS-0057-P Proposal to Improve the Prior Authorization Process

As healthcare organizations strive for improved patient outcomes and operational efficiencies, interoperability and prior authorization processes have become increasingly important topics of discussion. In an effort to address these issues, the Centers for Medicare and Medicaid Services (CMS) has released a proposed rule, CMS-0057-P, which aims to advance interoperability and improve prior authorization processes. This fact sheet aims to summarize the key points of the proposed rule and its potential impact on the healthcare industry.

The proposed rule is a comprehensive approach to addressing the challenges that healthcare organizations face with regard to interoperability and prior authorization processes. The proposed rule aims to improve the exchange of electronic health information between healthcare providers, payers, and other stakeholders and to streamline the prior authorization process for services and procedures. By implementing these changes, CMS aims to reduce administrative burdens on healthcare providers and improve the overall quality of care…

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