CMS Final Rule Allows Use of Medicare Claims to Assess Providers' Performance

CMS has released a final rule that allows for the use of standardized extracts of Medicare claims data for qualified entities to measure healthcare providers' and suppliers' performance.

Under the new final rule, entities can become qualified by CMS and pay to receive standardized extracts of claims data under Medicare Parts A, B and D for the purpose of evaluation of the performance of healthcare providers and suppliers.

The final rule also makes this data less costly for qualified entities to acquire than the interim rule proposed; gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers; and extends the time period for healthcare providers to confidentially review and appeal performance reports before they become public.

The rule also includes strict privacy and security requirements to protect patients, healthcare providers and suppliers as well as stringent penalties for any misuse of Medicare data.

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