CMS permits sale of Medicare claims data to providers, employers

CMS has finalized rules permitting designated organizations to share or sell claims data and analyses to providers, employers and other parties to use the information to improve care.


The rule affects the Qualified Entity Program, authorized by the Affordable Care Act, that allows organizations meeting certain qualifications to access patient-protected Medicare data to produce public reports. CMS provides qualified entities Medicare part A and B claims data and Part D drug event data "at a fee equal to the cost of producing the data." Qualified entities must combine Medicare claims data with non-Medicare claims data for analyses. The data may only be used to evaluate the performance of providers and suppliers.

The rules, now finalized by the Medicare Access and CHIP Reauthorization Act, permit organizations approved as qualified entities to provide or sell analyses of Medicare and private sector claims data to providers, employers "and other groups who can use the data to support improved care," according to CMS. Qualified entities will also be permitted to sell claims data itself to providers, suppliers, hospital associations and medical societies.

Qualified entities can sell combined data or provide the Medicare claims data alone at no cost.

As of March 18, 15 certified qualified entities are in the data sharing program. Organizations that wish to access data as a qualified entity must submit an application outlining, among other elements, how they plan to use the data to evaluate provider and supplier performance.

Stipulations of the newly finalized rules include privacy and security requirements for all entities receiving data and annual reporting requirements. Some data may include identifiable information, according to CMS, in which case organizations must comply with all HIPAA protections outlined in the law's privacy and security rules.

"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," CMS Chief Data Officer Niall Brennan said in a statement.

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