The Centers for Medicare and Medicaid Services plans to publish a final rule to make standardized extracts of Medicare claims data available to measure the performance of providers and suppliers.

CMS has sent the rule to the Office of Management and Budget for review, which is one of the last steps before publication. The rule is mandated under the Affordable Care Act.

The proposed rule, published on June 8, 2011, covered Medicare Parts A, B and D. Under the proposed rule, "qualified entities" may receive the data for the sole purpose of evaluating providers and suppliers and to generate specified public reports. The entities must pay a fee equal to the cost of making the data available, and must combine it with claims data from other sources when conducting evaluations.

The proposed rule defined a qualified entity "as a public or private entity that: (1) is qualified, as determined by the Secretary, to use claims data to evaluate the performance of providers of services and suppliers on measures of quality, efficiency, effectiveness, and resources use, and (2) agrees to meet the requirements of the Act and meets stated regulatory requirements at Sec.  401.703 through 401.710 of the Act" (Social Security Act).

Qualified entities would generally be required, with certain exceptions permitted, to use standard measures for evaluating performance. "We believe the sharing of Medicare data with qualified entities through the program and the resulting reports produced by qualified entities would be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general," according to the proposed rule.


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