"Qualified Entity Program"

CMS has published a final rule to 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. CMS expects the rule to lead to “more transparency regarding provider and supplier performance and innovative uses of data that will result in improvements to the healthcare delivery system while still ensuring appropriate privacy and security protections for beneficiary-identifiable data.” As mandated by the Medicare Access and CHIP Reauthorization Act (MACRA), qualified entities will 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. The rule includes annual reporting requirements, along with privacy and security rules to protect beneficiary information, including protections for patient-identifiable data that are at least as stringent as what is required of covered entities and their business associates for protected health information (PHI) under HIPAA.
Continue Reading CMS Finalizes Plan to Expand Medicare/Private Claims Data Available for Care Improvement

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

On June 8, 2011, CMS published a proposed rule that would implement an ACA requirement to make standardized extracts of Medicare Parts A, B, and D claims data available to “qualified entities.” These entities will combine this Medicare data with private sector claims data to generate public reports evaluating the performance of providers and