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Considerations for a Transition to Electronic Prior Authorization

Considerations for a Transition to Electronic Prior Authorization

Most parties agree that today’s prior authorization (PA) processes are too burdensome. The use of automated tools to share needed information between health plans and providers, often referred to as electronic prior authorization (ePA), could be one way to simplify this process and create efficiencies. To better understand the view from the ground, AHIMA contracted with Alazro Consulting to conduct structured interviews with a range of payers, providers, and experts from the field to understand the current PA landscape and key considerations that would need to be addressed as part of a transition to ePA.

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Post-Election Update: What Does it Mean for Healthcare in 2025?

Summit | March 17-18, 2025|

AHIMA Advocacy Summit 2025: Registration Now Open

Presented by the American Health Information Management Association® (AHIMA), the 2025 AHIMA Advocacy Summit is your chance to be part of a transformative event that brings together AHIMA members, health leaders, and policymakers to help shape the future of health information. Join us in Washington, DC, to discuss the policies that impact our field and to make your voice heard on the issues that matter most to our profession and the communities we serve. Don’t miss this opportunity to connect, advocate, and inspire change. Learn more and secure your spot today!

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The AHIMA-Endorsed MATCH IT Act Introduced in the US House of Representatives

The AHIMA-Endorsed MATCH IT Act Introduced in the US House of Representatives

Representatives Mike Kelly (R-PA) and Bill Foster (D-IL) have introduced the Patient Matching and Transparency in Certified Health IT (MATCH IT) Act of 2024 into the US House of Representatives. This bill, endorsed by AHIMA and the Patient ID Now coalition, aims to improve patient matching to protect patients’ safety and privacy and create a more interoperable health system. Read the press release and act now.

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Stakeholder Letter Regarding Telehealth Sent to Congressional Leadership

December 12, 2024

Stakeholder Letter Regarding Telehealth Sent to Congressional Leadership

AHIMA joined nearly 300 organizations calling for an extension of current telehealth flexibilities in an end-of-year package to ensure predictability in the healthcare system and prevent interruptions in patient care.

AHIMA Comments on C&M Code Proposals Under Consideration for October 2025 Implementation

November 15, 2024

AHIMA Comments on C&M Code Proposals Under Consideration for October 2025 Implementation

AHIMA submitted comments to the Centers for Disease Control and Prevention/National Center for Health Statistics and the Centers for Medicare & Medicaid Services on ICD-10-CM/PCS code proposals discussed at the September ICD-10 Coordination and Maintenance (C&M) Committee meeting and being considered for implementation on October 1, 2025.

AHIMA Comments on C&M Code Proposals

October 11, 2024

AHIMA Comments on ICD-10-CM/PCS Code Proposals

AHIMA submitted comments to the Centers for Disease Control and Prevention/National Center for Health Statistics and the Centers for Medicare & Medicaid Services on ICD-10-CM/PCS code proposals discussed at the September ICD-10 Coordination and Maintenance (C&M) Committee meeting and being considered for implementation on April 1, 2025.

AHIMA Comments on HTI-2 Proposed Rule

October 1, 2024

AHIMA Comments on HTI-2 Proposed Rule

AHIMA submitted comments to the Office of the Assistant Secretary for Technology Policy Office of the National Coordinator for Health Information Technology (ASTP) on the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule.

AHIMA Comments on CY 2025 Medicare Physician Fee Schedule Proposed Rule

September 3, 2024

AHIMA Comments on CY 2025 Medicare Physician Fee Schedule Proposed Rule

AHIMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the Calendar Year (CY) 2025 Medicare Physician Fee Schedule proposed rule. Our comments included responses to two requests for information on services addressing health-related social needs and public health reporting and data exchange.

AHIMA Leads Multi-Organization CURES 2.0 Request for Information Response

August 5, 2024

AHIMA Leads Multi-Organization CURES 2.0 Request for Information Response

AHIMA led, in conjunction with Blue Shield of California, a letter garnering nearly 40 organizational signers in support of policies to accelerate progress of the secure exchange of electronic health information. These policies would be essential to empowering patients with a full view of their digital health record and clinicians with the information they need to make informed care decisions, while being foundational to the overarching goals of the Cures 2.0 initiative.

AHIMA Nominates CIP Codes for DHS’ STEM Designated Degree Program List

July 15, 2024

AHIMA Nominates CIP Codes for DHS’ STEM Designated Degree Program List

AHIMA nominated seven Classification of Instructional Programs (CIP) codes relating to the health information (HI) profession for inclusion in the US Department of Homeland Security’s (DHS’) STEM Designated Degree Program List. The DHS’ STEM Designated Degree Program List is a complete list of fields of study that DHS considers to be science, technology, engineering or mathematics (STEM) fields of study.

AHIMA Issues Compliance Resource for OCR HIPAA Privacy Rule to Support Reproductive Healthcare Privacy Final Rule

July 15, 2024

AHIMA Issues Compliance Resource for OCR HIPAA Privacy Rule to Support Reproductive Healthcare Privacy Final Rule

AHIMA developed a resource to assist organizations in complying with the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) HIPAA Privacy Rule to Support Reproductive Healthcare Privacy final rule.

FAQ: ONC Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) Proposed Rule

July 11, 2024

FAQ: ONC Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) Proposed Rule

The Office of the National Coordinator for Health Information Technology (ONC) released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule on July 10. This rule reflects ONC’s efforts to advance interoperability and improve information sharing among patients, providers, payers, and public health authorities. The proposed rule builds on policies included in the ONC Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) final rule. AHIMA published a one-page FAQ describing key provisions of the final rule.

AHIMA Leads Multi-Organization Letter in Response to Change Healthcare Incident

July 1, 2024

AHIMA Leads Multi-Organization Letter in Response to Change Healthcare Incident

AHIMA led a letter signed by several healthcare provider organizations recommending that the Department of Health and Human Services and its federal partners use their regulatory authorities to mitigate the impact of cybersecurity attacks in the future, through increased resiliency, transparency, and after-incident support.

AHIMA Comments on Medicare Hospital IPPS Proposed Rule

June 4, 2024

AHIMA Comments on Medicare Hospital IPPS Proposed Rule

AHIMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the Fiscal Year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) proposed rule.

OCR Issues FAQ on Change Healthcare Cybersecurity Incident

June 4, 2024

OCR Issues FAQ on Change Healthcare Cybersecurity Incident

The US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) provided an FAQ in response to questions around breach notification requirements following the Change Healthcare cybersecurity incident. AHIMA published a summary of the FAQ.

AHIMA Co-Leads Multi-Organization Letter of Support Advocating for ONC Funding

May 28, 2024

AHIMA Co-Leads Multi-Organization Letter of Support Advocating for ONC Funding

AHIMA led, in conjunction with HIMSS and CHIME, a letter garnering over 50 signers in support of increased funding for the Office of the National Coordinator for Health Information Technology (ONC). Increased funding would support advancing interoperability and information sharing and exchange, coordinating federal and state-level digital health transformation, and supporting the modernization of the U.S. public health data infrastructure.

AHIMA Comments on ICD-10-CM Code Proposals

May 17, 2024

AHIMA Comments on ICD-10-CM Code Proposals

AHIMA submitted comments to the Centers for Disease Control and Prevention/National Center for Health Statistics on ICD-10-CM code proposals discussed at the March ICD-10 Coordination and Maintenance Committee meeting. If approved, these code proposals would become effective on October 1, 2025.

HIPAA Privacy Rule to Support Reproductive Health Care Privacy Final Rule Released

May 9, 2024

HIPAA Privacy Rule to Support Reproductive Health Care Privacy Final Rule Released

The Biden-Harris Administration, through the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR), released the HIPAA Privacy Rule to Support Reproductive Health Care Privacy Final Rule on April 22. The final rule modifies the HIPAA Privacy Rule to strengthen privacy protections for individuals’ protected health information (PHI) related to reproductive healthcare. AHIMA published a summary of the final rule.

Nondiscrimination in Health Programs and Activities Final Rule Released

May 8, 2024

Nondiscrimination in Health Programs and Activities Final Rule Released

The US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) released the Nondiscrimination in Health Programs and Activities final rule on April 26. The final rule modifies Section 1557 of the Affordable Care Act (ACA) which prohibits certain practices in healthcare to protect against discrimination. AHIMA published a summary of the final rule. 

Federal Trade Commission Releases Health Breach Notification Rule

May 8, 2024

Federal Trade Commission Releases Health Breach Notification Rule

The Federal Trade Commission (FTC) released its finalized Health Breach Notification Rule (HBNR) on April 26. The rule seeks to regulate non-HIPAA covered personal health records (PHRs) to notify customers of data breaches. AHIMA published a summary of the final rule. 

AHIMA Responds to Request for Information on Use of Artificial Intelligence in the Healthcare Industry

May 2, 2024

AHIMA Responds to Request for Information on Use of Artificial Intelligence in the Healthcare Industry

AHIMA responded to US Representative Ami Bera's request for information which invited responses on the uses and impacts of artificial intelligence within the healthcare ecosystem.

AHIMA Comments on ICD-10-PCS Code Proposals

April 19, 2024

AHIMA Comments on ICD-10-PCS Code Proposals

AHIMA submitted comments to the Centers for Medicare & Medicaid Services on ICD-10-PCS code proposals discussed at the March ICD-10 Coordination and Maintenance Committee meeting. These code proposals are being considered for implementation on October 1, 2024.

Fact Sheet: FY 2025 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule

April 17, 2024

Fact Sheet: FY 2025 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule, which updates the Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025. The proposed rule also includes provisions related to addressing social determinants of health (SDOH), strengthening emergency preparedness, and improving maternal health.

AHIMA Comments on USCDI v5

April 11, 2024

AHIMA Comments on USCDI v5

AHIMA submitted comments regarding the Office of the National Coordinator for Health IT (ONC) request for comment on the Draft United States Core Data for Interoperability (USCDI) Version 5. In its comments, AHIMA expressed support for ONC’s continued expansion and advancement of USCDI through the addition of data classes and elements.

Sharing information

April 4, 2024

Fact Sheet: Office of Management and Budget Notice – Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity

The US Office of Management and Budget (OMB) released a notice of decision announcing revisions to the Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity.

Sharing information

April 2, 2024

FAQ: CMS Updates to State Operations Manual Patient Informed Consent Requirements for Sensitive Examinations

The Centers for Medicare and Medicaid Services (CMS), in conjunction with the Office for Civil Rights (OCR), released new guidance via a revision in the State Operations Manual, related to informed consent for training and education-related examinations outside the medically necessary procedure. AHIMA published a one-page FAQ.
AHIMA Joins More Than 170 Organizations in Advocating for AHRQ Funding

February 26, 2024

AHIMA Joins More Than 170 Organizations in Advocating for AHRQ Funding

AHIMA joined more than 170 organizations in signing on to the Friends of AHRQ (Agency for Healthcare Research and Quality) FY25 Appropriations Request letter, which asks for additional funding that would be used for research on our nation's health systems in order to improve healthcare quality, reduce costs, advance patient safety, decrease medical errors, and broaden access to essential services.

Image of data transfer on a computer screen

February 13, 2024

FAQ: HHS OCR/SAMHSA Confidentiality of Substance Use Disorder Patient Records Final Rule

The US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and Substance Abuse and Mental Health Services Administration (SAMHSA) published their joint Confidentiality of Substance Use Disorder (SUD) Records final rule aligning 42 CFR Part 2 with the Health Insurance Portability and Accountability Act (HIPAA). AHIMA previously provided comment on the proposed rule in 2023 supporting many proposals and urging modification to others. AHIMA published a one-page FAQ describing key provisions of the final rule.

AHIMA Encourages HHS to Designate ICD-11 Office

January 30, 2024

AHIMA Encourages HHS to Designate ICD-11 Office

AHIMA sent a letter to the Secretary of Health and Human Services (HHS) encouraging HHS to designate an office within HHS to serve as a central coordinating entity for evaluation, planning, and potential adoption of ICD-11.

Healthcare costs and fees

January 19, 2024

FAQ: Advancing Interoperability and Improving Prior Authorization Processes Final Rule

The Centers for Medicare & Medicaid Services (CMS) released the Advancing Interoperability and Prior Authorization Processes final rule. CMS stated the goal of this final rule is to “improve the electronic exchange of health care data, as well as to streamline prior authorization processes” for both payers and providers.

Information Transfer

December 19, 2023

FAQ: Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule 

The Office of the National Coordinator for Health Information Technology (ONC) released the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) final rule. The final rule implements provisions directed by the 21st Century Cures Act and makes enhancements to the ONC Health IT Certification Program. AHIMA published a one-page FAQ describing key provisions of the final rule.

AHIMA Comments on Proposed Rule Implementing Disincentive Process for Health Care Providers Found Guilty of Information Blocking

December 11, 2023

AHIMA Comments on Proposed Rule Implementing Disincentive Process for Health Care Providers Found Guilty of Information Blocking

AHIMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) on the 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking proposed rule.

AHIMA Comments on C&M Code Proposals Under Consideration for October 2024 Implementation

November 14, 2023

AHIMA Comments on C&M Code Proposals Under Consideration for October 2024 Implementation

AHIMA submitted comments to the Centers for Disease Control and Prevention/National Center for Health Statistics and the Centers for Medicare & Medicaid Services on ICD-10-CM/PCS code proposals discussed at the September ICD-10 Coordination and Maintenance Committee meeting that are being considered for implementation on October 1, 2024.

FAQ: Executive Order on Safe, Secure, and Trustworthy Artificial Intelligence

November 13, 2023

FAQ: Executive Order on Safe, Secure, and Trustworthy Artificial Intelligence

The Biden-Harris Administration released the Executive Order on Safe, Secure, and Trustworthy Artificial Intelligence, aiming to use the extent of the Executive Branch’s current authorities to regulate the use of artificial intelligence (AI) both within and outside of the US Federal Government. AHIMA published an FAQ document describing key provisions of this Executive Order.

FAQ: 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking Proposed Rule

November 1, 2023

FAQ: 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking Proposed Rule

The US Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released the 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking proposed rule implementing the disincentive process for health care provider actors found guilty of information blocking. AHIMA published a one-page FAQ describing key provisions of the proposed rule.

Health Information Workforce Shortages Persist as AI Shows Promise: AHIMA Survey Reveals

November 1, 2023

Health Information Workforce Shortages Persist as AI Shows Promise: AHIMA Survey Reveals

The American Health Information Management Association (AHIMA) has unveiled findings from a recent survey shedding light on the ongoing workforce challenges in the health information (HI) profession.

AHIMA Comments on C&M Code Proposals Under Consideration for April 2024 Implementation

October 6, 2023

AHIMA Comments on C&M Code Proposals Under Consideration for April 2024 Implementation

AHIMA submitted comments to the Centers for Disease Control and Prevention/National Center for Health Statistics and the Centers for Medicare & Medicaid Services on ICD-10-CM/PCS code proposals discussed at the September ICD-10 Coordination and Maintenance Committee meeting that are being considered for implementation on April 1, 2024.

AHIMA Comments on Medicare Physician Fee Schedule Proposed Rule

September 8, 2023

AHIMA Comments on Medicare Physician Fee Schedule Proposed Rule

AHIMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the Calendar Year (CY) 2024 Medicare Physician Fee Schedule proposed rule. In addition to commenting on proposed modifications to the Quality Payment Program, AHIMA commented on a proposal to separately identify a social determinants of health (SDOH) risk assessment.

AHIMA Comments on Proposed Changes to Inpatient Prospective Payment System (IPPS) Medicare Code Editor

September 6, 2023

AHIMA Comments on Proposed Changes to Inpatient Prospective Payment System (IPPS) Medicare Code Editor

AHIMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes to the IPPS Medicare Code Editor revision process that were included in the Calendar Year 2024 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

AHIMA Comments on FTC Health Breach Notification Proposed Rule

August 8, 2023

AHIMA Comments on FTC Health Breach Notification Proposed Rule

AHIMA submitted comments to the Federal Trade Commission (FTC) on the Health Breach Notification Proposed Rule. The FTC seeks to better protect the privacy and security of personal health data amid the rise in health apps and other direct-to-consumer technologies, the increased collection of health data from consumers, and the risk of companies inappropriately using or disclosing sensitive data.

Sharing information

June 30, 2023

FAQ: OIG Information Blocking Enforcement Final Rule

The US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released its Grants, Contracts, and other Agreements: Fraud and Abuse; Information Blocking; Office of the Inspector General’s Civil Money Penalty Rules final rule implementing the information blocking investigation process for all actors and the penalty process for health information network (HIN), health information exchange (HIE), and developer of certified health IT product actors. AHIMA published a one-page FAQ describing key provisions of this final rule.

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