What's up with the Patient Access Rule?

Medicare Blue Button

The Medicare Blue Button application allows a patient to download their Medicare claims data to their computer to print it or share it with others using an application authorized by Medicare. The patient can then easily share their data with doctors, pharmacies, caregivers, or others. This Medicare service, called Blue Button, was released in 2018.

By linking their data to apps authorized by Medicare, the patient can:

• Access and share all Part A (Hospital Insurance), Part B (Medical Insurance), and Part D (Medicare drug plan) claims with doctors and others they choose.
• Manage their health with other computer-based services the apps offer.
• Control their health information.

Patient Access Rule (Medicare Advantage, Medicaid)

The Interoperability and Patient Access final rule delivers on the Medicare's promise to put patients first, giving them access to their health information when they need it most and, in a way, they can best use it. This rule is focused on driving interoperability and patient access to health information by requiring the sharing of patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers.

CMS-regulated payers, specifically Medicare Advantage, Medicaid programs, CHIP, and QHP issuers are required to implement and maintain a secure, standards-based (HL7 FHIR) API that allows patients to easily access their claims and encounter information, including cost, as well as a defined sub-set of their clinical information through third-party applications of their choice.?

Claims data, used in conjunction with clinical data, can offer a broader and more holistic understanding of an individual’s interactions with the healthcare system, leading to better decision-making and better health outcomes.

These payers were required to implement the Patient Access API beginning July 2021.

FHIR

Fast Healthcare Interoperability Resources is a standard describing data formats and elements and an application programming interface for exchanging electronic health records. The standard was created by the Health Level Seven International health-care standards organization.

Many electronic health record (EHR) companies have implemented FHIR as a standard to exchange data with other applications.

The Result

The result of Medicare Blue Button, the Patient Access Rule, and FHIR technologies in the EHR is a true path to interoperability for a comprehensive digital health history.

A patient's health history is?a key factor in timely and accurate diagnosis of illness and leads to improved outcomes. A thorough social and environmental health history can be just as informative as the physical examination and diagnostics in the diagnosis and prompt treatment of illness.?

It is important for such health history to be complete and accurate, and the release and use of these data sets will supply such capabilities.

A digital health history will also eliminate frustration for patients and healthcare teams while increasing patient and staff engagement. Additionally, it will save healthcare staff and patient's time, eliminate waste, and mitigate risk.

To learn more about implementing a digital health history form using the above data sets, contact Kris Gates at [email protected] or 402.321.6188