Section 10322 of the Patient Protection and Affordable Care Act


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Federal agency guidance


Effective January 1, 2012, the Secretary of HHS will make available to qualified entities certain Medicare data for the evaluation of the performance of providers and suppliers. The data are standardized extracts of claims data under parts A, B, and D for items and services furnished for one or more specified geographic areas and time periods requested by a qualified entity.

Qualifed Entities are defined as public or private entities that are qualified to use claims data to evaluate the performance of providers and suppliers on measures of quality, efficiency, effectiveness, and resource use. The qualified entities will be required to pay a fee to obtain the data and must submit to the Secretary of HHS a description of the methodologies that will be used to evaluate the performance of providers and suppliers.

Reports made by qualifying entities must include an understandable description of the measures, risk adjustment methods, physician attribution methods, other applicable methods, data specifications and limitations, and the sponsors, so that consumers, providers of services and suppliers, health plans, researchers, and other stakeholders can assess such reports. In addition, prior to any public release, the report must be made available to any provider or supplier that will be identified in the report with an opportunity to appeal and correct errors.