CMS Rule

As a payer, what do I need to know about the provider requirements and their impact on my business and members?

Improving care coordination and interoperability requires effort from both payers and providers. One of the key benefits of
mandating provider compliance is the increased amount of patient information that will become digitally available, advancing payer-provider data exchange efforts and improving care quality and other value-based care initiatives. The following components of the final interoperability rule apply to the providers in your networks:

Final Rule Component

Applicable Providers

Details

Applicable Date

Public Reporting &
Information Blocking
Eligible clinicians, hospitals
and CAHs in the Promoting
Interoperability Program
To further reduce information blocking, CMS will begin publicizing a list of all providers who submit a “no” response to any of the three Prevention of Information Blocking Attestation statements under the Medicare FFS Promoting Interoperability Program. Providers will have 30 days to contest prior to publication. CMS reporting goes live in late 2020, using 2019 report data
Digital Contact Information All individual health care
providers, facilities, or
practices
Just as payers need to provide an updated Provider Directory API, providers must maintain digital contact information in the National Plan and Provider Enumeration System (NPPES). CMS will publicly report providers that do not comply with this rule. CMS reporting goes live in late 2020
Admission, Discharge,
& Transfer (ADT) Event
Notifications
Hospitals, psychiatric
hospitals, and Critical Access
Hospitals (CAHs)
To improve care coordination, hospitals with EHRs will be required to alert providers when their patients are admitted, discharged, transferred or receive any services in the ED. May 1, 2021

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