New rules gives providers and employers improved access to information for better patient care

July 27th, 2016

If there weren’t already enough pressing reasons for accurate and precise documenting and coding in the healthcare world, now enter MACRA. The Medicare Access and CHIP Reauthorization Act, known as MACRA, is the next generation of healthcare legislation. In short, the law (which already is more than 900 pages long) hopes to drive the mass transition to value-based reimbursement, with doctors getting paid based on the quality of their work and the steps they take to improve their practices. It provides expanded opportunity for the use of Medicare and private sector claims data to drive higher quality, lower cost care

Medicare Data for the Taking

According to the Centers for Medicare & Medicaid Services (CMS) new rules have recently been finalized that will expand access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery and quality improvement. The new rules, as required by MACRA, seek to enhance the current qualified entity program to allow innovative use of Medicare data for non-public quality improvement and care delivery efforts while ensuring the privacy and security of beneficiary information.

Under the new rules, qualified entities may provide or sell claims data to providers and suppliers, such as doctors, nurses, and skilled nursing facilities among others. The rule also includes strict privacy and security requirements for all entities receiving patient identifiable and beneficiary de-identified analyses or data, as well as expanded annual reporting requirements.

For example, qualified entities can conduct analyses on chronically ill or other resource-intensive populations to increase quality and drive-down costs in the healthcare system. If entities receive patient identifiable data or analyses, they must use protections that are at least as stringent as what is required of covered entities and their business associates for protected health information under the HIPAA Privacy and Security Rules.

CMS says that increasing access to analyses and data that include Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions. Qualified entities must combine the Medicare data with other claims data (e.g., private payer data) to produce quality reports that are representative of how providers and suppliers are performing across multiple payers, for example Medicare, Medicaid, or various commercial payers.

Currently, 15 organizations have applied and received approval to be a qualified entity.  Of these organizations, two have completed public reporting while the other 13 are preparing for public reporting.

Once MACRA is finalized in November, providers may have to implement practices by January 2017 if CMS keeps to the original proposed schedule. Reimbursement rates and bonuses in the year 2019 will be based on metrics from 2017.

With all of this data available for the taking, it’s never been more imperative for accurate documentation, coding and reporting. Learn how Elsevier can ensure your organization is prepared to deliver the quality of documentation required under today’s standards.