Home > Medicare, research > CMS Publishes Final Rule on Release of Medicare Claims Data for Performance Measurement by Qualified Entities

CMS Publishes Final Rule on Release of Medicare Claims Data for Performance Measurement by Qualified Entities

On December 7, the Centers for Medicare and Medicaid Services (CMS) published its final rule to implement Section 10332 of the Affordable Care Act allowing the release and use of standardized extracts of Medicare claims data for quality measurement.  Under this rule, “qualified entities” can purchase (at cost) access to certain Medicare claims data extracts and use the data to develop and publish reports about the performance of providers and suppliers.  The qualified entities are required to combine the Medicare data with non-Medicare claims data in the development of the evaluations.

Prospective qualified entities must meet certain eligibility criteria, successfully navigate an application/review process, and sign a data use agreement.  Qualified entities are required to ensure the privacy and security of the data and are prohibited from using the data for any purpose other than the specific evaluation.  Furthermore, qualified entities must give providers/suppliers who are the subject(s) of the report an opportunity to review and suggest corrections prior to publication.

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Categories: Medicare, research
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