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January 25, 2018


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Medical Coding News Archives

Consumers May Get Access to Comprehensive Quality and Cost Information

 
June 7, 2011:

Health care consumers will be able to get a complete picture of providers’ and suppliers’ quality of care and costs if a recently published proposed rule is finalized. The rule would allow qualified organizations to publicize health care quality and cost information compiled from multiple sources, a vast improvement over current, piecemeal releases of such information.

Qualified organizations would be allowed access to patient-protected Medicare data that, when combined with private sector data, would highlight the hospitals and other providers offering the best, most cost-effective care. Currently, employers, consumers and providers often rely on just one health plan’s data, which reflect only a portion of any given provider’s costs and services. The same provider may be shown to offer top-notch care cost effectively according to one health plan’s information, while appearing to provide low-quality services at a high cost according to another plan’s data.

This proposed rule, published June 8 in the Federal Register, is part of the Obama administration’s efforts to lower costs while improving care under the Affordable Care Act. Having comprehensive data on health care services would enable health care consumers to compare providers in their areas and make informed decisions about their care.

An organization would be considered qualified to compile provider and supplier data if it had claims data from sources other than Medicare and if it could show that it could safeguard the access, use, and security of Medicare claims data. Qualified entities would then pay a fee to cover CMS’s costs of providing the data. CMS would in turn provide standardized extracts of Medicare claims data from Parts A, B, and D for one or more defined geographic areas.

In addition:

  • Qualified entities could use the data only to create reports evaluating provider and supplier performance.
  • Reports would be sent to the profiled providers and suppliers before their release so that necessary corrections could be made.
  • The reports would show only aggregate information and would not show individual patient or beneficiary information.

CMS would continually monitor qualified organizations to make sure they adhere to the approved processes outlined above and would sanction or terminate from the program those violating the procedures.

 

 
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