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CMS Proposes Medicare Data Transparency Rules

June 6, 2011
by root
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Newly proposed rules from the Centers for Medicare & Medicaid Services (CMS) would allow Medicare and private sector claims data to be used to produce public reports that measure the performance of doctors, hospitals and other healthcare providers.

The new rules will allow organizations that meet certain qualifications access, for a fee, to patient-protected Medicare data from Parts A, B and D. These reports will combine private sector claims data with Medicare claims data to identify which hospitals and doctors provide the highest quality, cost-effective care.

To receive the Medicare claims data, qualified entities would need to have claims data from other sources. To prevent mistakes in reporting results, entities must share the reports confidentially with providers and suppliers prior to their public release—giving providers and suppliers a chance to review the reports and provide necessary corrections.

Publicly released reports would contain aggregated information only and during the application process. Qualified entities would need to demonstrate their capabilities to govern the access, use and security of Medicare claims data.

The set of proposed rules are open for comment.