5 Points on CMS' Proposed Rule on Releasing Claims Data

CMS' proposed rule on the release and use of Medicare Parts A, B and D claims data to qualified entities to assess hospital performance could have far-reaching implications on hospitals and other healthcare providers. 

The proposed rule, which would take effect in 2012, would release certain Medicare claims data to qualified entities, for a fee, so they may measure the performance of providers and suppliers and generate public reports.

Here are five points of note on the proposed rule.

1. Eligibility qualifications. Not every healthcare entity will meet the eligibility criteria. In order to be a qualified entity, the rule states that an organization will be tested across three criteria: organizational and governance capabilities, additions of claims data from other sources and data privacy and security. While they do not plan on limiting the number of qualified entities, each one must meet the standards for those three conditions. Applications must also be submitted by March 31, 2012, and subsequently by the end of the first quarter of each calendar year.

2. Reports for qualified entities. Upon meeting the requirements of a qualified entity, that organization then must submit a list to CMS of all measures it plans on using from the data, the geographic areas it plans on covering and the methods of creating and distributing its reports. Qualified entities must also submit a description of how they would allow providers and suppliers to obtain and view the data reports confidentially and a description of how they plan on making the data reports available to the public.

3. Adherence to data use agreement. CMS is emphasizing that qualified entities guarantee the privacy and security of all received data. By complying with the data use agreement, qualified entities cannot transmit CMS data via unsecured telecommunications and must inform each beneficiary if that beneficiary's data has been or is believed to have been inappropriately acquired.

4. Requests from providers and suppliers. Before making data reports open to the public, qualified entities must give providers of services and suppliers ample time to view the report as well as requesting error corrections. All measures, methodologies, and results must be confidentially shared to those providers and suppliers at least 30 business days before making the reports public. However, adherence to the data use agreement must also stay at the forefront of all shared, secured reports.

5. Grounds for termination of qualified entities. CMS may end any agreement with a qualified entity if that organization fails to report accurately all requested information, fails to submit and apply a corrective action plan, violates the data use agreement, no longer meets eligibility qualifications or is a part of any other serious violation within the qualified entity program.

Read the entire CMS' proposed CMS-5059-P Availability of Medicare Data for Performance Measurement.

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