Wednesday, August 19, 2026

CMS published a proposed rule, CMS-0057-F, aimed at encouraging faster adoption of electronic prior authorization using FHIR standards. The rule includes reporting requirements for payers on decision timeframes and denial rates, with CMS responding to AMA concerns about the burden of manual prior authorization processes. The proposal is part of a broader push to automate and standardize prior authorization, a core driver of administrative cost and delay. The public comment period will open soon; practices should monitor for the final rule's specific reporting requirements and any new technical standards that may require EHR updates.

A coalition of remote patient monitoring technology vendors, including Smart Meter, is mobilizing to oppose CMS's proposed 2027 Physician Fee Schedule changes. The vendors argue the proposed reimbursement cuts would force clinics to scale back or eliminate RPM programs, directly impacting patient access to chronic care management. The 2027 PFS is still in the proposed rule stage, with the final rule expected by November 1, 2026. Practices currently billing for RPM (CPT codes 99453, 99454, 99457, 99458) should model the financial impact of the proposed cuts now and prepare to submit comments to CMS during the open period to advocate for sustainable payment rates.

Revenue cycle management firm R1 RCM announced an agreement to acquire Humata Health, a startup specializing in AI-driven prior authorization. The acquisition aims to integrate Humata's automation, which reportedly achieves up to 96% first-pass approval rates, into R1's Phare OS platform. This move signals continued industry consolidation around AI tools designed to tackle the high-cost, high-volume prior authorization workflow. For independent practices, it represents a growing market of third-party automation vendors but does not change immediate payer policies or submission requirements.

California Medicaid expansion enrollees face a looming asset test reinstatement expected to shrink enrollment. The state's Healthy Families program has delayed this asset verification, but Medi-Cal managed care plans are anticipating significant member churn. The policy shift could strip coverage from beneficiaries who accumulate modest savings. For independent practices, a fluctuating Medicaid population complicates eligibility verification and increases risk of patient self-pay defaults. Monitor California Department of Health Care Services updates for the asset verification go-live date, expected before 2027.

STAT+ reports healthcare costs for cities and counties are surging, undermining public sector budgets. The analysis shows these employers, long seen as offering generous benefits, are now shifting costs to employees through higher premiums, deductibles, and narrowed networks. This accelerates the trend of patients delaying or avoiding care due to out-of-pocket costs. For clinics, it means more patient financial responsibility and tougher collections. These trends will pressure your front desk to verify patient responsibility in real time and may increase bad debt from city and county employees.