CMS has issued a proposed rule that would allow organizations approved as "qualified entities" to confidentially share or sell analyses of Medicare and private-sector claims data to providers, employers, and other groups who can use the data to support improved care. Qualified entities would be required to combine the Medicare data with other claims data (such as private payer data) to produce reports on provider and supplier performance across multiple payers. This proposal, which is authorized by the Medicare Access and CHIP Reauthorization Act (MACRA), would build on a current program established under the Affordable Care Act (ACA) that enables qualified entities to use Medicare claims data in combination with other non-Medicare claims data to evaluate the performance of providers and suppliers. Thirteen organizations have received approval to be a qualified entity under the ACA program. The proposed rule includes annual reporting requirements, along with privacy and security rules to protect beneficiary information. Comments on the proposed rule will be accepted until March 29, 2016.
This article is presented for informational purposes only and is not intended to constitute legal advice.