How providers can manage payer request for EHR data access

Payers increasingly are seeking direct access to providers’ systems for automated medical record collection and aggregation, but providers may be wary.

In a recent posting from the American Health Information Management Association, Rita Bowen and Greg Ford examine how organizations should handle health insurers that ask for access to a provider’s electronic health records system.

Rita Bowen is vice president of privacy, compliance and HIM policy at MRO, a health information management firm, and Greg Ford is director of requester relations and receivables administration at MRO.

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Insurers contend that this direct access can expedite claims processing, reviews and audits without having a negative impact on the provider.

However, there are risks to providers’ financial health, privacy, security and information governance if they give payers this access. “Providers should recognize they have choices about how to share this data with payers, and they should carefully evaluate the benefits and risks to their organizations and patients when doing so,” Bowen and Ford caution.

Consequently, they offer four recommendations to help providers decide whether to share.

  • For claims processing purposes, providers can grant manual access to claims-specific encounters with appropriate access and security restrictions. When handled properly, improved efficiency can benefit the provider.
  • However, providers should not give payers unrestricted or automated access to the entire patient chart. Rather, they should permit only controlled access to preloaded information that the payer needs. Patients consenting to automated data sharing for the provision of care do not intend to share with payers whose interests are not aligned with the patient’s privacy and financial concerns.
  • Maintain health information management governance of release of information for post-payment audits and reviews, including HEDIS and risk adjustment.
  • Negotiate with payers to receive a share of any financial benefits that payers achieve from the HEDIS and risk adjustment reviews. If this is not possible, be sure to recoup the costs of releasing data to the payer.
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