Although it was signed into law in 2016, portions of the 21st Century Cures Act, the provisions designed to support interoperability continue created the need for new rules by the Centers for Medicare and Medicaid Services and the Office of National Coordinator for Health IT.
The CMS Interoperability and Patient Access Rule and ONC’s Interoperability Rule were finalized in May 2020. Although Covid-19 delayed enforcement, that’s about to change.
One requirement that both payer systems and electronic health records (EHRs) must be capable of exchanging medical information through patient and provider APIs are critical to eliminate information blocking and siloed information that can thwart interoperability. The CMS rule requires an API for payer-to-payer information exchange.
Another component of the rule takes a tougher stance on price transparency. It increases the penalty for hospitals that do not comply with the Hospital Price Transparency final rule. The fines established by CMS start at $300 per day for smaller hospitals with a bed count of 30 or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than 30, according to a CMS press release.
A webinar sponsored by Intelligent Medical Objects scheduled for April 11 at 2pm ET will explore how payers are meeting these needs when it comes to providing access to structured medical data for members.
A recent whitepaper from Intelligent Medical Objects highlights the role of payers in achieving interoperability.
“The CMS rule specifically changes the role payers play in the interoperability equation by requiring them to be partners in health information exchange with patients, other payers, and providers. This is a major change for payers, who have not had to comply with regulations to ensure access and transparency in the past.”
This not only has implications for how members access their own medical data but also has implications for things like price transparency for medical procedures. Among the topics the webinar discussion will highlight are:
- Creating cohorts for patients with chronic conditions
- How cohorts can be used for population health
- Price transparency
- Risk mitigation
- Coordination of information blocking rules with ONC, OCR, CMS
- Implications for standardizing and normalizing data
- Recently proposed changes to HIPAA
To register for the April 11 webinar, please fill out the form below.
Photo: metamorworks, Getty Images
