New York Healthcare Intel

The state has released a dataset showing locations of Article 28, 36, 40, and 7 health care facilities from the Health Facilities Information System, currently featuring hospitals and hospital extension clinics with additional facility types to follow.

The Health Facilities Information System (HFIS) has released a new dataset mapping Article 28, 36, and 40 health care facilities, currently showing hospitals and hospital extension clinics with additional facility types to follow.

Three application defects routinely delay payor enrollment: incomplete work-history explanations for any gap over 30 days, a malpractice carrier-history that does not reconcile with the explanation, and CAQH attestation that has lapsed. Each forces a back-and-forth with the credentialing committee.

The MIPS cost performance category is calculated retrospectively by CMS using attributed Medicare claims; clinicians cannot directly affect what is attributed. The two attribution methods (TPCC and MSPB) capture different beneficiary cohorts. Practices that try to "manage" cost without understanding which patients are attributed to which clinician typically waste effort.

Across most payors, the top-five denial reasons account for over 80% of prior-auth rejections: missing clinical documentation, wrong CPT/HCPCS code, service not in benefit plan, step-therapy not completed, and ordering provider not on the patient's plan. The same five repeat across plans because they are the easiest to deny on automation.