Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2.3. Other Administrative Health Information Exchange

10/29/2013

LTPAC providers exchange health information in support of administrative processes such as billing and required reporting.

  • Quality Measure Reporting. LTAPC sites are collecting and/or submitting quality measure data to support grants and initiatives. EMHS Pioneer ACO is required to report 33 quality or performance measures electronically to CMS (see Appendix L for detailed measures). The data is collected through various mechanisms depending on the data elements -- through the EHR or abstracted from medical records and reported through a defined facility process.

    CMS also requires electronic submission of federally mandated data or item sets (MDS, OASIS, inpatient rehabilitation facility-patient assessment instrument [IRF-PAI], Hospice Item Sets,p LTCH Care Data Setq). The CMS electronic transmission requirements for assessments do not leverage available HIT standards. CMS uses assessment data for several purposes including calculating quality measures.

  • Mandatory Reporting. Public health authorities and state agencies may maintain registries or repositories for reportable public health data. The type of data to report varies by community and state. For example, immunization data or influenza and pneumonia data may be reportable information to public health agencies to detect outbreaks. Some states, such as New York, have customized electronic web portals to enter and submit reportable data.

  • Payment. LTPAC providers may exchange electronic health information with payers to support their case management and claims adjudication processes. Payers may request, in electronic formats, relevant medical record documentation to assess continued coverage, validate services billed, or determine medical necessity. Requested documentation may include physician orders, certification/recertifications, progress notes, flow sheets, medication and treatment administration records, assessments, and other relevant data determined by the payer.

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