CMS Publishes Proposed Rule to Allow the Release of Medicare Claims Data


On June 8, 2011, CMS published a Notice of Proposed Rulemaking (“NPRM”) to implement a provision of the Affordable Care Act (“ACA”) giving qualified entities access to Medicare claims data for use in evaluating the performance of health care providers.

This NPRM seeks to implement an ACA provision that will make available Medicare claims data for the purpose of allowing private entities to prepare publicly available evaluations and comparisons of provider performance. The NPRM describes how an organization that meets extensive qualification requirements may pay an annual fee to access patient-level Medicare Parts A, B, and D data. These entities will combine Medicare data with private-sector claims data that they already have access to in order to prepare public reports measuring the performance of physicians, other providers, and suppliers. The intent of the law and NPRM is to help consumers and payors make informed decisions about their health care by selecting the highest-quality providers in their areas.

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